Provider Demographics
NPI:1114203676
Name:WAICE, JACQUELINE (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:WAICE
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 WINDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-4123
Mailing Address - Country:US
Mailing Address - Phone:570-956-1956
Mailing Address - Fax:
Practice Address - Street 1:5064 ROSWELL RD
Practice Address - Street 2:SUITE C-201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2281
Practice Address - Country:US
Practice Address - Phone:404-233-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008886111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician