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General NPI Number Information
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NPI Number | 1730287582
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Entity Type | Organization
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Legal Business Name | ALPHARETTA BACK AND NECK CENTER
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 3502 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4458
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Country | US
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Telephone | 251-610-9614
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Fax | 770-997-1599
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Provider Business Mailing Address
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Address Line | 3502 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4458
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Country | US
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Telephone | 251-610-9614
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Fax | 770-997-1599
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Authorized Official
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Title or Position | DC OWNER
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Name | ALBERT J DIVAGNO
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Credential | D.C.
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Telephone | 251-610-9614
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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 | GA1707
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License Number State | GA
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