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Organization
BACK TO BASIC HEALTH CHIROPRACTIC
Active
Organization
BACK TO BASIC HEALTH CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY ANNE VACCARO DC (OWNER)
(678) 494-6735
Entity
Organization
Contact information
Practice address
5101 OLD HWY 5, SUITE 1, WOODSTOCK, GA 30188
(678) 494-6735
(678) 494-6737
Mailing address
PO BOX 2031, ACWORTH, GA 30102
(678) 494-6735
(678) 494-6737
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4718
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00804207A
—
GA
01
—
4718
CHIROPRACTIC
—
Enumeration date
05/08/2007
Last updated
10/20/2010
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