Provider Demographics
NPI:1396844403
Name:BRAGG, CHRIS D (DC)
Entity Type:Individual
Prefix:MISS
First Name:CHRIS
Middle Name:D
Last Name:BRAGG
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 1:4445 PINEWALK DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7079
Mailing Address - Country:US
Mailing Address - Phone:678-867-9604
Mailing Address - Fax:
Practice Address - Street 1:8610 ROSWELL RD
Practice Address - Street 2:SUITE 750
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-7534
Practice Address - Country:US
Practice Address - Phone:770-998-1678
Practice Address - Fax:770-587-1679
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGJBMedicare ID - Type UnspecifiedCHIROPRACTOR