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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