Healthcare Provider Details

I. General information

NPI: 1164692067
Provider Name (Legal Business Name): JOSEPH PETER TAVERNEY JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH PETER TAVERNEY JR. D.C.

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MAIN ST
CARTERSVILLE GA
30120-3335
US

IV. Provider business mailing address

145 W SKYLINE VW
DALLAS GA
30157-7459
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-5262
  • Fax: 770-386-0502
Mailing address:
  • Phone: 770-743-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number001749
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number001749
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009438
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: