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General NPI Number Information
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NPI Number | 1588908685
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Entity Type | Organization
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Legal Business Name | BETTER SPINE BETTER HEALTH, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 6630 MCGINNIS FERRY RD SUITE B
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1542
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Country | US
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Telephone | 678-473-0552
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Fax | 678-473-0656
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Provider Business Mailing Address
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Address Line | 6630 MCGINNIS FERRY RD SUITE B
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1542
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Country | US
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Telephone | 678-473-0552
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Fax | 678-473-0656
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAN KYU PARK
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Credential | D.C.
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Telephone | 678-473-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIR009022
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License Number State | GA
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