MEDICARE: GOOD SPINES ONLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1396565818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SPINES ONLY LLC

Provider Business Mailing Address
First Line	:	3133 MAPLE DR. STE 240
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2509
Country	:	US
Telephone Number	:	678-435-7149
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 MAPLE DR. STE 240
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2509
Country	:	US
Telephone Number	:	678-435-7149
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAISIA R GLENN
Credential	:
Telephone Number	:	678-435-7149

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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Directions to “GOOD SPINES ONLY LLC ” Practice Location

Language	Start Address	Practice Location

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