Provider Demographics
NPI:1003933086
Name:WISKIND, JARED T (DC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:T
Last Name:WISKIND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 NORCROSS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3867
Mailing Address - Country:US
Mailing Address - Phone:678-321-1710
Mailing Address - Fax:378-321-1711
Practice Address - Street 1:139 NORCROSS ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3867
Practice Address - Country:US
Practice Address - Phone:678-321-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO008042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA37-1538968OtherTAX ID