# DECATUR NECK AND BACK

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Georgia Neck and Back
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780880302
- **Authorized official:** DR. TONY BANGUILAN D.C. (OFFICE MANAGER)
- **Authorized official phone:** (770) 963-5585

## Contact information

- **Practice address:** 960 HERRINGTON RD, SUITE B, LAWRENCEVILLE, GA 30044-7212
- **Practice address phone:** (770) 963-5585
- **Practice address fax:** (770) 682-7636
- **Mailing address:** 960 HERRINGTON RD, SUITE B, LAWRENCEVILLE, GA 30044-7212
- **Mailing address phone:** (770) 963-5585
- **Mailing address fax:** (770) 682-7636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | CHIR006452 | GA | — |
| 111NR0400X | Rehabilitation Chiropractor | CHIR008031 | GA | Yes |
| 207Q00000X | Family Medicine Physician | 016356 | GA | — |

## Other

- **Enumeration date:** 06/21/2007
- **Last updated:** 09/11/2025