Provider Demographics
NPI:1033827381
Name:MINOR, RAVEN (DC)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:MINOR
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 1:1050 SHILOH RD NW STE 303
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7197
Mailing Address - Country:US
Mailing Address - Phone:770-370-7588
Mailing Address - Fax:
Practice Address - Street 1:1050 SHILOH RD NW STE 303
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7197
Practice Address - Country:US
Practice Address - Phone:770-370-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty