Healthcare Provider Details

I. General information

NPI: 1598894784
Provider Name (Legal Business Name): GWINNETT CHIROPRACTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2659
US

IV. Provider business mailing address

2027 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2659
US

V. Phone/Fax

Practice location:
  • Phone: 770-338-1422
  • Fax: 770-338-5274
Mailing address:
  • Phone: 770-338-1422
  • Fax: 770-338-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO06164
License Number StateGA

VIII. Authorized Official

Name: DR. RYAN J SIEGMUND
Title or Position: OWNER
Credential: D.C.
Phone: 770-338-1422