Provider Demographics
NPI:1568190445
Name:PETRINI, RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:PETRINI
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 1:2920 MARIETTA HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8207
Mailing Address - Country:US
Mailing Address - Phone:770-580-0123
Mailing Address - Fax:770-720-4626
Practice Address - Street 1:2920 MARIETTA HWY STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8207
Practice Address - Country:US
Practice Address - Phone:770-580-0123
Practice Address - Fax:770-720-4626
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor