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General NPI Number Information
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NPI Number | 1376896563
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Entity Type | Organization
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Legal Business Name | INTELLIGENT CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 5871 GLENRIDGE DR NE SUITE 115
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City | ATLANTA
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State | GA
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Zip | 30328-5375
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Country | US
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Telephone | 404-531-9525
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Fax | 404-531-9842
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Provider Business Mailing Address
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Address Line | 5871 GLENRIDGE DR NE SUITE 115
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City | ATLANTA
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State | GA
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Zip | 30328-5375
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Country | US
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Telephone | 404-531-9525
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Fax | 404-531-9842
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | SALVATORE J MINICOZZI
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Credential | D.C.
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Telephone | 404-531-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO05349
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License Number State | GA
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