Provider Demographics
NPI:1578807368
Name:DUKE, JOHN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:DUKE
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 1:1455 BELLS FERRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6078
Mailing Address - Country:US
Mailing Address - Phone:770-693-0707
Mailing Address - Fax:770-693-0930
Practice Address - Street 1:1455 BELLS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6078
Practice Address - Country:US
Practice Address - Phone:678-643-7205
Practice Address - Fax:678-643-7205
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5676111N00000X
GA005676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR0005676OtherGA LICENSE NUMBER