Healthcare Provider Details

I. General information

NPI: 1376659847
Provider Name (Legal Business Name): JEREMY THOMAS DIMARTINO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 BIRMINGHAM RD SUITE 811
MILTON GA
30004-4417
US

IV. Provider business mailing address

15800 BIRMINGHAM HWY STE 500
MILTON GA
30004-4423
US

V. Phone/Fax

Practice location:
  • Phone: 678-266-3300
  • Fax: 678-266-3322
Mailing address:
  • Phone: 770-455-5002
  • Fax: 678-266-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010478
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR008758
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: