The Back Shack LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR006338 Issued in GA

Legal business name

THE BACK SHACK LLC

Practice address

6740 James B Rivers Dr
Stone Mountain, GA 30083-2235

Phone

(404) 775-9642

NPI assigned

Dec 15, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Feschuk

Title

Doctor

Phone

(404) 775-9642

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366675200000",
    "number": "1003051343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6740 JAMES B RIVERS DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300832235",
            "telephone_number": "404-775-9642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6740 JAMES B RIVERS DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300832235",
            "telephone_number": "404-775-9642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BACK SHACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-15",
        "last_updated": "2013-04-23",
        "status": "A",
        "authorized_official_last_name": "FESCHUK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "404-775-9642"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR006338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.