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General NPI Number Information
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NPI Number | 1669016143
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Entity Type | Organization
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Legal Business Name | ATLANTA UPPER CERVICAL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/10/2021
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Provider Practice Location Address
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Address Line | 125 E TRINITY PLACE SUITE #247
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City | DECATUR
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State | GA
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Zip | 30030
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Country | US
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Telephone | 470-347-3737
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Fax | 470-347-3738
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Provider Business Mailing Address
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Address Line | 125 E TRINITY PLACE SUITE #247
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City | DECATUR
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State | GA
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Zip | 30030
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Country | US
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Telephone | 470-347-3737
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Fax | 470-347-3738
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Authorized Official
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Title or Position | CLINIC DIRECTOR/OWNER
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Name | BAXTER SMITH
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Credential | D.C.
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Telephone | 470-347-3737
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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 |
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License Number State |
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