Provider Demographics
NPI:1669348793
Name:SPINE CHIROPRACTIC
Entity type:Organization
Organization Name:SPINE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRANAV
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-954-7244
Mailing Address - Street 1:2679 BRIDLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7380 SPOUT SPRINGS RD STE 140
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-7535
Practice Address - Country:US
Practice Address - Phone:770-954-7244
Practice Address - Fax:470-822-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty