Restoration Spine & Sport Chiropractic

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

RESTORATION SPINE & SPORT CHIROPRACTIC

Practice address

110 Evans Mill Dr Ste 309
Dallas, GA 30157-1623

Phone

(678) 594-3579

NPI assigned

Mar 27, 2019

Last updated

Mar 27, 2019By 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. Martin R Wilson, DCNPI 1609314723

Title

Ceo

Phone

(678) 594-3579

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.

• Martin Ralph Wilson, D.C.

  • Chiropractor
  • Dallas, GA
  • NPI 1609314723
  Authorized official Same address or phone

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1902367535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EVANS MILL DR STE 309",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301571623",
            "telephone_number": "678-594-3579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EVANS MILL DR STE 309",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301571623",
            "telephone_number": "678-594-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION SPINE & SPORT CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-27",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-594-3579",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; 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.