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General NPI Number Information
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NPI Number | 1437546538
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Entity Type | Organization
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Legal Business Name | COMMERCE SPINAL CENTER, PC
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 6323 GRAND HICKORY DR SUITE 300B
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City | BRASELTON
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State | GA
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Zip | 30517-6272
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Country | US
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Telephone | 470-238-3456
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Fax | 470-238-3455
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Provider Business Mailing Address
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Address Line | 6323 GRAND HICKORY DR SUITE 300B
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City | BRASELTON
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State | GA
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Zip | 30517-6272
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Country | US
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Telephone | 470-238-3456
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Fax | 470-238-3455
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DEDRA LEANN DAWLEY
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Credential |
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Telephone | 470-238-3456
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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 | 08649
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License Number State | GA
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