Provider Demographics
NPI:1215461728
Name:CHIRO-DYNAMICS SPINE & JOINTS REHAB LLC
Entity type:Organization
Organization Name:CHIRO-DYNAMICS SPINE & JOINTS REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:PA, MD
Authorized Official - Phone:781-605-3438
Mailing Address - Street 1:1744 ROSWELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3979
Mailing Address - Country:US
Mailing Address - Phone:404-552-2807
Mailing Address - Fax:781-605-3438
Practice Address - Street 1:42 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5014
Practice Address - Country:US
Practice Address - Phone:781-605-3438
Practice Address - Fax:781-605-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty