NPIMap

Organization Active NPI

Decatur Neck and Back

Doing business as Georgia Neck and Back

  • Rehabilitation Chiropractor
  • Lawrenceville, GA
National Provider Identifier
1780880302
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
CHIR008031 Issued in GA
Legal business name
DECATUR NECK AND BACK
Doing business as
Georgia Neck and Back
Practice address
960 Herrington Rd
Suite B
Lawrenceville, GA 30044-7212
Phone
(770) 963-5585
Fax
(770) 682-7636
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Tony Banguilan, D.C.NPI 1275738296
Title
Office Manager
Phone
(770) 963-5585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X CHIR006452 GA
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X CHIR008031 GA Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 016356 GA

Addresses

Primary practice location

960 Herrington Rd
Suite B
Lawrenceville, GA 30044-7212

Mailing address

960 Herrington Rd
Suite B
Lawrenceville, GA 30044-7212
Phone (770) 963-5585

Other names 1

  • Georgia Neck and Back Doing business as

National Provider Directory

National Provider Directory

Locations

960 Herrington Rd
#B
Lawrenceville, GA 30044
Phone (770) 963-5585

960B Herrington Rd
Lawrenceville, GA 30044
Phone (770) 963-5585

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1780880302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 HERRINGTON RD",
            "address_2": "SUITE B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447212",
            "telephone_number": "770-963-5585",
            "fax_number": "770-682-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 HERRINGTON RD",
            "address_2": "SUITE B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447212",
            "telephone_number": "770-963-5585",
            "fax_number": "770-682-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR NECK AND BACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BANGUILAN",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-963-5585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR006452",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR008031",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "016356",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Neck and Back",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.