Healthcare Provider Details

I. General information

NPI: 1659628196
Provider Name (Legal Business Name): DIMARTINO CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 BIRMINGHAM RD SUITE 811
MILTON GA
30004-4417
US

IV. Provider business mailing address

980 BIRMINGHAM RD SUITE 811
MILTON GA
30004-4417
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4309
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008758
License Number StateGA

VIII. Authorized Official

Name: DR. JEREMY DIMARTINO
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 678-266-3300