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General NPI Number Information
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NPI Number | 1558606137
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Entity Type | Organization
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Legal Business Name | PEACHTREE CENTER REHAB LLC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 241 PEACHTREE ST NE MARTA LEVEL SUITE B
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City | ATLANTA
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State | GA
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Zip | 30303-1424
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Country | US
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Telephone | 404-522-9991
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Fax | 404-522-9890
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Provider Business Mailing Address
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Address Line | 241 PEACHTREE ST NE MARTA LEVEL SUITE B
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City | ATLANTA
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State | GA
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Zip | 30303-1424
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Country | US
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Telephone | 404-522-9991
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Fax | 404-522-9890
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEREMY JOSEPH BROE
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Credential | DOC
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Telephone | 404-522-9991
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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 | CHIRO007816
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License Number State | GA
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