11D2092707 CLIA NUMBER - SELANO CHIROPRACTIC CENTER

Laboratory Demographics

  • CLIA Code: 11D2092707
  • Facility Name: SELANO CHIROPRACTIC CENTER
  • Facility Address: 243 MERCHANTS DRIVE
    DALLAS, GA
    ZIP 30132
  • Facility Phone: 000 770-4451
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TABATHA A. MILLER
  • NPI Number: 1609096213
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 11D2092707
LAB Type Practitioner Other
Facility Name SELANO CHIROPRACTIC CENTER
Street 243 MERCHANTS DRIVE
City DALLAS
State GA
ZIP 30132
Phone 000 770-4451
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Practitioner Other
Lab Director TABATHA A. MILLER

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This page was last updated on: 9/29/2025