Provider Demographics
NPI:1699071662
Name:INTEGRITY SPINE AND WELLNESS
Entity type:Organization
Organization Name:INTEGRITY SPINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-317-6364
Mailing Address - Street 1:3320 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6542
Mailing Address - Country:US
Mailing Address - Phone:678-714-5722
Mailing Address - Fax:678-714-5724
Practice Address - Street 1:3320 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6542
Practice Address - Country:US
Practice Address - Phone:678-714-5722
Practice Address - Fax:678-714-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007116111N00000X
GAGA11414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty