Provider Demographics
NPI:1639491269
Name:DYKES, GREGORY RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RYAN
Last Name:DYKES
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 1:260 MANNING RD SW UNIT 155
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4657
Mailing Address - Country:US
Mailing Address - Phone:770-428-5242
Mailing Address - Fax:
Practice Address - Street 1:563 LAKELAND PLZ
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2784
Practice Address - Country:US
Practice Address - Phone:770-781-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor