Healthcare Provider Details

I. General information

NPI: 1457611220
Provider Name (Legal Business Name): DULUTH CHIROPRACTIC & ACUPUNCTURE CLINIC DCAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 OLD NORCROSS RD #400
DULUTH GA
30096-4335
US

IV. Provider business mailing address

3705 OLD NORCROSS RD #400
DULUTH GA
30096-4335
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-7676
  • Fax: 770-476-7679
Mailing address:
  • Phone: 770-476-7676
  • Fax: 770-476-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008481
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number236
License Number StateGA

VIII. Authorized Official

Name: JOOYOUNG KIM
Title or Position: CEO
Credential: D.C
Phone: 770-476-7676