Provider Demographics
NPI:1093885964
Name:PIDGEON, DANIEL WILLIAM JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:PIDGEON
Suffix:JR
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 1:4900 STEWART MILL RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6725
Mailing Address - Country:US
Mailing Address - Phone:678-838-0313
Mailing Address - Fax:678-838-0306
Practice Address - Street 1:4900 STEWART MILL RD.
Practice Address - Street 2:SUITE D
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6725
Practice Address - Country:US
Practice Address - Phone:678-838-0313
Practice Address - Fax:678-838-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFSCMedicare ID - Type Unspecified