Individual
DR. MARK RESTIVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC NMT
Contact information
Practice address
101 CEDAR ROCK TRACE, WWW.CHIROPRACTICWORKS.COM/, ATHENS, GA 30605-3217
(706) 367-1208
Mailing address
101 CEDAR ROCK TRCE, WWW.CHIROPRACTICWORKS.COM/, ATHENS, GA 30605-7701
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CHIROO7190
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010736948
SECONDARY TAX ID
GA
Enumeration date
05/08/2007
Last updated
11/30/2016
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