Provider Demographics
NPI:1962875831
Name:GABELLA BRAIN AND SPINE CLINIC
Entity type:Organization
Organization Name:GABELLA BRAIN AND SPINE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-902-4827
Mailing Address - Street 1:1280 W PEACHTREE ST NW
Mailing Address - Street 2:UNIT 3401
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3445
Mailing Address - Country:US
Mailing Address - Phone:678-902-4827
Mailing Address - Fax:
Practice Address - Street 1:1280 W PEACHTREE ST NW
Practice Address - Street 2:UNIT 3401
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3445
Practice Address - Country:US
Practice Address - Phone:678-902-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009410111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty