Provider Demographics
NPI:1265909162
Name:CALK, IAN (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:CALK
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 1:3000 JOHNSON FERRY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5697
Mailing Address - Country:US
Mailing Address - Phone:770-552-7979
Mailing Address - Fax:770-552-1153
Practice Address - Street 1:3000 JOHNSON FERRY RD STE 102
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5697
Practice Address - Country:US
Practice Address - Phone:770-552-7979
Practice Address - Fax:770-552-1153
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor