Provider Demographics
NPI:1053752758
Name:BRESLOW CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BRESLOW CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-813-1811
Mailing Address - Street 1:3500 DULUTH PARK LN
Mailing Address - Street 2:810
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3242
Mailing Address - Country:US
Mailing Address - Phone:770-813-1811
Mailing Address - Fax:770-813-1822
Practice Address - Street 1:3500 DULUTH PARK LN
Practice Address - Street 2:810
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3242
Practice Address - Country:US
Practice Address - Phone:770-813-1811
Practice Address - Fax:770-813-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR003006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBVGOtherMEDICARE