Provider Demographics
NPI:1760558886
Name:DOLAN, VINCENT P (DC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:P
Last Name:DOLAN
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 1:1301 E 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6460
Mailing Address - Country:US
Mailing Address - Phone:706-236-9100
Mailing Address - Fax:
Practice Address - Street 1:1301 E 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6460
Practice Address - Country:US
Practice Address - Phone:706-236-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005410111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU-62352Medicare UPIN
GA35ZCDKSMedicare ID - Type Unspecified