100 Chiro Burrell PC – Chiropractor in Decatur, GA

Key facts

NPI: 1619703386
Entity type: Organization (NPI type 2)
Primary specialty: Chiropractor 111N00000X
Legal business name: 100 CHIRO BURRELL PC
Practice address: 1605 Church St Ste 665
Decatur, GA 30033-6074
Phone: (404) 343-3304
NPI assigned: Sep 10, 2024
Organization subpart: No

Authorized official

Name: Ricardo Burrell
Title: Manager
Phone: (404) 343-3304

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Kirsten Thomas, DC Chiropractor · Decatur, GA · NPI 1609697713

Medicare reassignment NPD CHIROPRACTOR · GA
Allison M Jancik, DC Chiropractor · Atlanta, GA · NPI 1497254213

NPD (past) CHIROPRACTOR
Xavier Ortiz Valle, DC Chiropractor · Decatur, GA · NPI 1245798545

NPD (past) CHIROPRACTOR

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20250122000943	GA	Part B Supplier - Clinic/Group Practice	9638608524	Receives reassigned benefits from 1 practitioner Practice locations: Decatur, GA

National Provider Directory

Locations

1605 Church St
Ste 665
Decatur, GA 30033
Phone (404) 343-3304

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor Group: 193400000X SINGLE SPECIALTY GROUP	111N00000X			Yes

Addresses

Primary practice location

1605 Church St Ste 665
Decatur, GA 30033-6074

Mailing address

1605 Church St Ste 665
Decatur, GA 30033-6074

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 11, 2024.

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1619703386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 CHURCH ST STE 665",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 CHURCH ST STE 665",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336074",
            "telephone_number": "404-343-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "100 CHIRO BURRELL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "BURRELL",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-343-3304"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

All providers in Decatur, GA · Chiropractor in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.