Provider Demographics
NPI:1518971308
Name:BYRD, JON SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:SCOTT
Last Name:BYRD
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 1:2639 HICKORY GROVE RD NW
Mailing Address - Street 2:STE 150
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3629
Mailing Address - Country:US
Mailing Address - Phone:770-974-2408
Mailing Address - Fax:770-974-2411
Practice Address - Street 1:2639 HICKORY GROVE RD NW STE 150
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3680
Practice Address - Country:US
Practice Address - Phone:770-974-2408
Practice Address - Fax:770-974-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7051111N00000X
GACHIR007051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCGVDMedicare ID - Type Unspecified