Provider Demographics
NPI:1164633863
Name:DIMOLA FAMIILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DIMOLA FAMIILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-924-1995
Mailing Address - Street 1:4515 DENNINGTON TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8551
Mailing Address - Country:US
Mailing Address - Phone:770-889-8941
Mailing Address - Fax:770-924-3930
Practice Address - Street 1:221 RIVER PARK NORTH DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7835
Practice Address - Country:US
Practice Address - Phone:770-924-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU64852Medicare UPIN
GA35ZCDWHMedicare ID - Type UnspecifiedMEDICARE