Provider Demographics
NPI:1386155778
Name:C.I.A. CHIROPRACTOR IN ATLANTA, INC.
Entity type:Organization
Organization Name:C.I.A. CHIROPRACTOR IN ATLANTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-497-8356
Mailing Address - Street 1:2085 METROPOLITAN PKWY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-5926
Mailing Address - Country:US
Mailing Address - Phone:404-305-0036
Mailing Address - Fax:
Practice Address - Street 1:2085 METROPOLITAN PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5926
Practice Address - Country:US
Practice Address - Phone:404-305-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME INTEGRATIVE HEALH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-12
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty