Provider Demographics
NPI:1043851058
Name:DOLMA, SONAM (DC)
Entity Type:Individual
Prefix:
First Name:SONAM
Middle Name:
Last Name:DOLMA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:PAIGE
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:920 PINE GROVE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2703
Mailing Address - Country:US
Mailing Address - Phone:812-483-1732
Mailing Address - Fax:
Practice Address - Street 1:115 VICKERY ST STE 103
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4980
Practice Address - Country:US
Practice Address - Phone:404-500-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor