Provider Demographics
NPI:1639216161
Name:SUPNICK, TODD M (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:SUPNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2829 WATTS DR NW
Mailing Address - Street 2:STE B
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2722
Mailing Address - Country:US
Mailing Address - Phone:770-429-0707
Mailing Address - Fax:770-425-9020
Practice Address - Street 1:2829 WATTS DR NW
Practice Address - Street 2:STE B
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2722
Practice Address - Country:US
Practice Address - Phone:770-429-0707
Practice Address - Fax:770-425-9020
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR007097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor