Basic Information
| Provider Information | |||||||||
| NPI: | 1154427086 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHIROPRACTIC CENTER OF ROME PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 REDMOND RD NW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062348221 | ||||||||
| FaxNumber: | 7062919647 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 REDMOND RD NW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062348221 | ||||||||
| FaxNumber: | 7062919647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 11/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DOCTOR OF CHIROPRACTIC | ||||||||
| AuthorizedOfficialTelephone: | 7062348221 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 111N00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1134150824 | 01 | GA | IND.#-WILLIAM HUDGINS RPT | OTHER | 1811982036 | 01 | GA | IND.#-WALTER BURT,DC | OTHER | 1457345936 | 01 | GA | IND.# JAMES NELSON,D.C. | OTHER |