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General NPI Number Information
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NPI Number | 1891983631
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Entity Type | Organization
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Legal Business Name | ADVANCED PAIN & SPINE CENTER
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 246 CREEKSTONE RDG
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City | WOODSTOCK
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State | GA
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Zip | 30188-3732
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Country | US
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Telephone | 678-494-9960
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Fax |
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Provider Business Mailing Address
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Address Line | 246 CREEKSTONE RIDGE
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City | WOODSTOCK
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State | GA
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Zip | 30188
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Country | US
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Telephone | 678-494-9960
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID PAUL SIKANOWICZ
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Credential |
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Telephone | 678-494-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIR006757
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License Number State | GA
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