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General NPI Number Information
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NPI Number | 1629018007
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Entity Type | Organization
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Legal Business Name | ALL-PRO CHIROPRACTIC & PAIN SPECIALISTS
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3035 FIVE FORKS TRICKUM RD SW SUITE 7
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City | LILBURN
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State | GA
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Zip | 30047-1806
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Country | US
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Telephone | 770-985-5223
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Fax | 770-985-5590
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Provider Business Mailing Address
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Address Line | 3035 FIVE FORKS TRICKUM RD SW SUITE 7
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City | LILBURN
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State | GA
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Zip | 30047-1806
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Country | US
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Telephone | 770-985-5223
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Fax | 770-985-5590
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. MATTHEW JOHN LOOP
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Credential | D.C.
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Telephone | 770-985-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIR007718
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License Number State | GA
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