Phillip Im, CHIR 007185

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR007185 Issued in GA

Practice address

2645 N Berkeley Lake Rd NW # D-126
Duluth, GA 30096-3002

Phone

(678) 571-7140

Fax

(470) 709-2187

NPI assigned

May 3, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Centro Hopkins Chiropractic

  • Chiropractor
  • Duluth, GA
  • NPI 1194083261
  Authorized official Same address or phone

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174745517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2645 N BERKELEY LAKE ROAD",
            "address_2": "D-126",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "678-571-7140",
            "fax_number": "470-709-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 N BERKELEY LAKE RD NW # D-126",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963002",
            "telephone_number": "678-571-7140",
            "fax_number": "470-709-2187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5312 Buford Hwy NE",
            "address_2": "B5",
            "address_purpose": "LOCATION",
            "city": "Doraville",
            "state": "GA",
            "postal_code": "303401152",
            "country_code": "US",
            "telephone_number": "678-571-7140",
            "fax_number": "678-205-5619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IM",
        "first_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "CHIR 007185",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR007185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Duluth, GA
• Providers in Duluth, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.