Healthcare Provider Details

I. General information

NPI: 1992902357
Provider Name (Legal Business Name): DANA G PICCIRILLO D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 NORTHLAKE PKWY BUILDING 6 SUITE 120
TUCKER GA
30084-4107
US

IV. Provider business mailing address

2181 NORTHLAKE PWKY BUILDING 6 SUITE 120
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 770-934-4233
  • Fax: 770-934-4234
Mailing address:
  • Phone: 770-934-4233
  • Fax: 770-934-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR007460
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: