Provider Demographics
NPI:1164692067
Name:TAVERNEY, JOSEPH PETER JR (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PETER
Last Name:TAVERNEY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:PETER
Other - Last Name:TAVERNEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:145 W SKYLINE VW
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-7459
Mailing Address - Country:US
Mailing Address - Phone:770-743-7214
Mailing Address - Fax:
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3335
Practice Address - Country:US
Practice Address - Phone:770-386-5262
Practice Address - Fax:770-386-0502
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001749111NI0013X, 111NR0400X
GACHIR009438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NR0400XChiropractic ProvidersChiropractorRehabilitation