Provider Demographics
NPI:1669838926
Name:DE GRAAF, DYLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:DE GRAAF
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 1:8314 OFFICE PARK DR
Mailing Address - Street 2:1C-1D
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134
Mailing Address - Country:US
Mailing Address - Phone:404-550-9398
Mailing Address - Fax:
Practice Address - Street 1:6740 SHANNON PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2057
Practice Address - Country:US
Practice Address - Phone:404-550-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor