Provider Demographics
NPI:1376659847
Name:DIMARTINO, JEREMY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:THOMAS
Last Name:DIMARTINO
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 1:15800 BIRMINGHAM HWY
Mailing Address - Street 2:STE 500
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4423
Mailing Address - Country:US
Mailing Address - Phone:770-455-5002
Mailing Address - Fax:678-266-3322
Practice Address - Street 1:980 BIRMINGHAM RD
Practice Address - Street 2:SUITE 811
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-4417
Practice Address - Country:US
Practice Address - Phone:678-266-3300
Practice Address - Fax:678-266-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010478111N00000X
GACHIR008758111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0034942136OtherBCBS PROVIDER #
ILK25301Medicare UPIN
IL0034942136OtherBCBS PROVIDER #