Provider Demographics
NPI:1760110373
Name:MODI, KARISHMA (DC)
Entity Type:Individual
Prefix:
First Name:KARISHMA
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 OLDE TOWNE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4399
Mailing Address - Country:US
Mailing Address - Phone:770-973-0150
Mailing Address - Fax:
Practice Address - Street 1:4799 OLDE TOWNE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4399
Practice Address - Country:US
Practice Address - Phone:770-973-0150
Practice Address - Fax:770-973-0140
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor