Provider Demographics
NPI:1992048136
Name:BODY CORE NEUROPATHY & SPINE GROUP
Entity type:Organization
Organization Name:BODY CORE NEUROPATHY & SPINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-993-6010
Mailing Address - Street 1:3855 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4195
Mailing Address - Country:US
Mailing Address - Phone:770-993-6010
Mailing Address - Fax:770-993-6011
Practice Address - Street 1:3855 SHALLOWFORD RD
Practice Address - Street 2:SUITE 510
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4195
Practice Address - Country:US
Practice Address - Phone:770-993-6010
Practice Address - Fax:770-993-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008654111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty