Provider Demographics
NPI:1154427086
Name:CHIROPRACTIC CENTER OF ROME PC
Entity type:Organization
Organization Name:CHIROPRACTIC CENTER OF ROME PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-234-8221
Mailing Address - Street 1:210 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1538
Mailing Address - Country:US
Mailing Address - Phone:706-234-8221
Mailing Address - Fax:706-291-9647
Practice Address - Street 1:210 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1538
Practice Address - Country:US
Practice Address - Phone:706-234-8221
Practice Address - Fax:706-291-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1134150824OtherIND.#-WILLIAM HUDGINS RPT
GA1811982036OtherIND.#-WALTER BURT,DC
GA1457345936OtherIND.# JAMES NELSON,D.C.
GA35ZCFGSMedicare ID - Type UnspecifiedJAMES C. NELSON, D.C.
GAGRP4714Medicare ID - Type UnspecifiedMEDICARE GROUP NO.
GA1811982036OtherIND.#-WALTER BURT,DC
GAU81718Medicare UPIN
GA35ZCGZGMedicare ID - Type UnspecifiedWALTER M. BURT, D.C.