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NORTHSIDE SPINAL CENTER INC NPI 1578789764


NPI Information

NPI: 1578789764
Provider Name: NORTHSIDE SPINAL CENTER INC
Classification: Chiropractor - 111N00000X
Entity Type: Organization

CLIA Number: 11D2128231

Address:
101 MOUNTAIN BROOK DR
SUITE 104
CANTON, GA
ZIP 30115
Phone: (678) 880-6616
Get Directions

NORTHSIDE SPINAL CENTER INC is a chiropractor in Canton, GA. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. NORTHSIDE SPINAL CENTER INC NPI is 1578789764. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

101 MOUNTAIN BROOK DR
SUITE 104
CANTON, GA
ZIP 30115-017
Phone: (678) 880-6616
Fax: (678) 880-6617

The provider's authorized official is George Gregory Davis .
The authorized official title is Owner and has the following contact phone number (678) 880-6616.

The CLIA number assigned to this NPI record is 11D2128231 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 3/21/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractorCHIR006295GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GRP6457MEDICARE PINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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