Provider Demographics
NPI:1194083261
Name:CENTRO HOPKINS CHIROPRACTIC
Entity type:Organization
Organization Name:CENTRO HOPKINS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-571-7140
Mailing Address - Street 1:2645 N BERKELEY LAKE RD NW
Mailing Address - Street 2:STE. D-126
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3002
Mailing Address - Country:US
Mailing Address - Phone:678-957-1050
Mailing Address - Fax:
Practice Address - Street 1:2645 N BERKELEY LAKE RD NW
Practice Address - Street 2:STE. D-126
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3002
Practice Address - Country:US
Practice Address - Phone:678-957-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty