Healthcare Provider Details

I. General information

NPI: 1043977747
Provider Name (Legal Business Name): REBECCA DUNKIN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAPLE ST
ROSWELL GA
30075-5014
US

IV. Provider business mailing address

4492 QUARTER HORSE DR NE
ROSWELL GA
30075-3154
US

V. Phone/Fax

Practice location:
  • Phone: 404-384-3175
  • Fax:
Mailing address:
  • Phone: 404-384-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010527
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR010527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: