Provider Demographics
NPI:1114424603
Name:TRAWICK, ETHAN COLE (DC)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:COLE
Last Name:TRAWICK
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 1:236 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-4396
Mailing Address - Country:US
Mailing Address - Phone:770-324-7277
Mailing Address - Fax:
Practice Address - Street 1:541 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2301
Practice Address - Country:US
Practice Address - Phone:770-748-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor