Provider Demographics
NPI:1053311159
Name:WEBSTER, JOHN A (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:WEBSTER
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 1:11490 ALPHARETTA HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3866
Mailing Address - Country:US
Mailing Address - Phone:770-442-3343
Mailing Address - Fax:770-576-0152
Practice Address - Street 1:11490 ALPHARETTA HIGHWAY STE. 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:910-642-2481
Practice Address - Fax:910-642-9010
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-08-11
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-26
Provider Licenses
StateLicense IDTaxonomies
NC1459111N00000X
GACHIR002163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08930OtherBLUE CROSS BLUE SHIELD
NC8908930Medicaid
NC08930OtherBLUE CROSS BLUE SHIELD
NC8908930Medicaid