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General NPI Number Information
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NPI Number | 1477922748
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Entity Type | Organization
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Legal Business Name | PURE CARE CENTER
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 3675 CRESTWOOD PKWY NW SUITE 290
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City | DULUTH
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State | GA
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Zip | 30096-1805
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Country | US
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Telephone | 770-212-9297
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Fax |
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Provider Business Mailing Address
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Address Line | 3675 CRESTWOOD PKWY NW SUITE290
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City | DULUTH
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State | GA
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Zip | 30096-1805
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Country | US
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Telephone | 770-212-9297
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW WORTHY
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Credential |
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Telephone | 770-212-9297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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