Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR006660 | GA |
NPI | 1174726343 |
---|---|
Provider Name | Eric C Tabano |
First Address | Suwanee, GA 30024-6056 |
Second Address | Acworth, GA 30024-6096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 11/12/2009 |