Provider Demographics
NPI:1033708466
Name:ROUTH, SYDNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:
Last Name:ROUTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 KENNESTONE CIR STE D211
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7403
Mailing Address - Country:US
Mailing Address - Phone:470-604-6817
Mailing Address - Fax:
Practice Address - Street 1:1290 KENNESTONE CIR STE D211
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7403
Practice Address - Country:US
Practice Address - Phone:470-604-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor