Provider Demographics
NPI:1629055348
Name:JUCKNIES, VERONICA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:LEE
Last Name:JUCKNIES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:LEE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:490 HENDERSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8585
Mailing Address - Country:US
Mailing Address - Phone:678-684-8023
Mailing Address - Fax:513-984-4909
Practice Address - Street 1:12600 DEERFIELD PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6130
Practice Address - Country:US
Practice Address - Phone:678-687-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010039111N00000X
GAPT0115702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic