100 Percent Chiropractic Atlanta Two LLC
Organization Active NPI Chiropractor · Buford, GA
NPI 1700159191 · NPPES record last updated Feb 15, 2012
Key facts
- NPI
- 1700159191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIR008877 (GA)
- Legal business name
- 100 PERCENT CHIROPRACTIC ATLANTA TWO LLC
- Practice address
- 1600 Mall of Georgia Blvd Ste 1110
Buford, GA 30519-8746 - Phone
- (770) 614-1009
- Fax
- (770) 614-1011
- NPI assigned
- Feb 15, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Steve K Nutty, D.C.
- Title
- Doctor/Owner
- Phone
- (315) 525-8770
Practitioners 3
-
Steven K Nutty, D.C.
-
Tan Phan, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120320000387 | GA | Part B Supplier - Clinic/Group Practice | 5890955454 |
Receives reassigned benefits from 1 practitioner Practice locations: Buford, GA |
National Provider Directory
Locations
3320 Buford Dr
Ste 60
Buford, GA 30519
Phone (770) 614-1009
1600 Mall of Georgia Blvd
Ste 1110
Buford, GA 30519
Phone (770) 614-1009
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIR008877 | GA | Yes |
Addresses
Primary practice location
1600 Mall of Georgia Blvd Ste 1110
Buford, GA 30519-8746
Mailing address
1600 Mall of Georgia Blvd Ste 1110
Buford, GA 30519-8746
Phone (770) 614-1009
Other providers in Buford, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2012. 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.