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General NPI Number Information
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NPI Number | 1497268494
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Entity Type | Organization
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Legal Business Name | SPINEALIGN CENTER LLC
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 1195 FAIRBURN RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-2150
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Country | US
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Telephone | 678-974-5462
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 FAIRBURN RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-2150
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Country | US
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Telephone | 678-974-5462
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHERRA CONDE
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Credential | DC
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Telephone | 678-974-5462
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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 | CHIR008915
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License Number State | GA
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