Provider Demographics
NPI:1295780708
Name:DIMOLA, ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:DIMOLA
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 1:4515 DENNINGTON TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 RIVER PARK NORTH DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7835
Practice Address - Country:US
Practice Address - Phone:770-924-1995
Practice Address - Fax:770-924-3930
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor