Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIR008886 | GA |
NPI | 1114203676 |
---|---|
Provider Name | Dr. Jacqueline Waice |
First Address | Ringgold, GA 30736-4123 |
Second Address | Atlanta, GA 30342-2281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2011 |
Last Update Date | 28/10/2011 |