Prosport Wellness Center, LLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

CHIR005750 Issued in GA

Legal business name

PROSPORT WELLNESS CENTER, LLC

Practice address

2000 Powers Ferry Rd.
Suite a
Marietta, GA 30067

Phone

(770) 454-8300

Fax

(770) 986-9962

NPI assigned

Mar 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael B Wax, D.C.NPI 1891066635

Title

Ceo

Phone

(770) 454-8300

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Wax, D.C.

  • Chiropractor
  • Atlanta, GA
  • NPI 1891066635
  Authorized official Same address or phone

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689798811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5464 PEACHTREE INDUSTRIAL BLVD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "30341",
            "telephone_number": "770-454-8300",
            "fax_number": "770-986-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 POWERS FERRY RD.",
            "address_2": "SUITE A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30067",
            "telephone_number": "770-454-8300",
            "fax_number": "770-986-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPORT WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAX",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-454-8300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR005750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Chiropractor in Marietta, GA
• Providers in Marietta, GA by specialty
• Rehabilitation Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.