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General NPI Number Information
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NPI Number | 1609096213
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Entity Type | Organization
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Legal Business Name | SELANO CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 243 MERCHANTS DRIVE
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City | DALLAS
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State | GA
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Zip | 30132
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Country | US
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Telephone | 770-445-1362
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Fax | 770-445-5860
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | DALLAS
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State | GA
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Zip | 30132-0008
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Country | US
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Telephone | 770-445-1362
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Fax | 770-445-5860
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Authorized Official
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Title or Position | CLINC DIRECTOR
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Name | DR. JEFFREY L SELANO
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Credential | DC
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Telephone | 770-445-1362
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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 | CHIR005181
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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