Provider Demographics
NPI:1972699601
Name:SOUTHMETRO CHIROPRACTIC CENTER, INC
Entity type:Organization
Organization Name:SOUTHMETRO CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-472-8989
Mailing Address - Street 1:7202 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1902
Mailing Address - Country:US
Mailing Address - Phone:770-472-8989
Mailing Address - Fax:770-472-8969
Practice Address - Street 1:7202 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1902
Practice Address - Country:US
Practice Address - Phone:770-472-8989
Practice Address - Fax:770-472-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2067111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU20462Medicare UPIN
GA35ZCDDGMedicare ID - Type UnspecifiedMEDICARE NUMBER