Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR010527 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIR010527 | GA |
NPI | 1043977747 |
---|---|
Provider Name | Rebecca Dunkin |
First Address | Roswell, GA 30075-3154 |
Second Address | Roswell, GA 30075-5014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |