Provider Demographics
NPI:1952071607
Name:PORTER, IAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:DAVID
Last Name:PORTER
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 1:605 VALLEY HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2445
Mailing Address - Country:US
Mailing Address - Phone:678-545-2020
Mailing Address - Fax:
Practice Address - Street 1:605 VALLEY HILL RD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2445
Practice Address - Country:US
Practice Address - Phone:678-545-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR007561OtherDOCTOR OF CHIROPRACTIC