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General NPI Number Information
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NPI Number | 1659411007
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Entity Type | Organization
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Legal Business Name | INTEGRATED CHIROPRACTIC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2964 PEACHTREE RD NW SUITE 105
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City | ATLANTA
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State | GA
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Zip | 30305-2153
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Country | US
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Telephone | 404-231-8770
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Fax | 404-231-8760
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Provider Business Mailing Address
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Address Line | 2964 PEACHTREE RD NW SUITE 105
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City | ATLANTA
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State | GA
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Zip | 30305-2153
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Country | US
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Telephone | 404-231-8770
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Fax | 404-231-8760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID L. OLT
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Credential | DC
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Telephone | 404-231-8770
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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 | CHIR005356
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License Number State | GA
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