Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR009438 | GA |
N | 111NI0013X | Independent Medical Examiner | 001749 | CT |
N | 111NR0400X | Rehabilitation Chiropractor | 001749 | CT |
NPI | 1164692067 |
---|---|
Provider Name | Mr. Joseph Peter Taverney JR. |
First Address | Dallas, GA 30157-7459 |
Second Address | Cartersville, GA 30120-3335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2008 |
Last Update Date | 01/10/2015 |