11D2285305 CLIA NUMBER - ALPHARETTA IVC

Laboratory Demographics

CLIA Number: 11D2285305

Facility Name: ALPHARETTA IVC

Facility Address:
3060 KIMBALL BRIDGE ROAD, SUITE 130
ALPHARETTA, GA
ZIP 30022
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Facility Phone Number: 470 235-2869

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487989208

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	11D2285305
LAB Type	Physician Office
Facility Name	ALPHARETTA IVC
Street	3060 KIMBALL BRIDGE ROAD, SUITE 130
City	ALPHARETTA
State	GA
ZIP	30022
Phone	470 235-2869
CertificateType	4
CertificateEffectiveDate	7/11/2023
CertificateExpirationDate	7/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024