Provider Demographics
NPI:1376192351
Name:DEARBORN, MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:DEARBORN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-3044
Mailing Address - Country:US
Mailing Address - Phone:734-818-9341
Mailing Address - Fax:
Practice Address - Street 1:2300 CAMP CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3313
Practice Address - Country:US
Practice Address - Phone:678-666-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10182111N00000X
GACHIR010182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor