Healthcare Provider Details

I. General information

NPI: 1356174387
Provider Name (Legal Business Name): DANA MOON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PEACHTREE INDUSTRIAL BLVD STE 4108
SUWANEE GA
30024-4541
US

IV. Provider business mailing address

1300 PEACHTREE INDUSTRIAL BLVD STE 4108
SUWANEE GA
30024-4541
US

V. Phone/Fax

Practice location:
  • Phone: 470-238-3683
  • Fax: 470-238-3816
Mailing address:
  • Phone: 470-238-3683
  • Fax: 470-238-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011256
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: