Healthcare Provider Details

I. General information

NPI: 1639491269
Provider Name (Legal Business Name): GREGORY RYAN DYKES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 LAKELAND PLZ
CUMMING GA
30040-2784
US

IV. Provider business mailing address

260 MANNING RD SW UNIT 155
MARIETTA GA
30064-4657
US

V. Phone/Fax

Practice location:
  • Phone: 770-781-9050
  • Fax:
Mailing address:
  • Phone: 770-428-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO08561
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: