Provider Demographics
NPI:1699930040
Name:NECK & BACK PAIN CHIROPRACTIC
Entity type:Organization
Organization Name:NECK & BACK PAIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:D
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-954-7224
Mailing Address - Street 1:1296 HWY 138
Mailing Address - Street 2:STE 105
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296
Mailing Address - Country:US
Mailing Address - Phone:678-954-7224
Mailing Address - Fax:678-954-7226
Practice Address - Street 1:1296 HWY 138
Practice Address - Street 2:STE 105
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296
Practice Address - Country:US
Practice Address - Phone:678-954-7224
Practice Address - Fax:678-954-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA352CGTPOtherMEDICARE
GA352CGTPOtherMEDICARE