Provider Demographics
NPI:1407568975
Name:CALVERT, LOGAN GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:GREGORY
Last Name:CALVERT
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 1:3625 DALLAS HWY SW STE 850
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5925
Mailing Address - Country:US
Mailing Address - Phone:678-571-1203
Mailing Address - Fax:
Practice Address - Street 1:3625 DALLAS HWY SW STE 850
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5925
Practice Address - Country:US
Practice Address - Phone:678-571-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor