Healthcare Provider Details

I. General information

NPI: 1164633863
Provider Name (Legal Business Name): DIMOLA FAMIILY CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7835
US

IV. Provider business mailing address

4515 DENNINGTON TRCE
CUMMING GA
30040-8551
US

V. Phone/Fax

Practice location:
  • Phone: 770-924-1995
  • Fax:
Mailing address:
  • Phone: 770-889-8941
  • Fax: 770-924-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR005520
License Number StateGA

VIII. Authorized Official

Name: DR. ANTHONY DIMOLA
Title or Position: CHIROPRACTOR
Credential:
Phone: 770-924-1995