Provider Demographics
NPI:1669094645
Name:MCDANIEL, JUSTIN (DC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MCDANIEL
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 1:650 HAMILTON AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3778
Mailing Address - Country:US
Mailing Address - Phone:404-888-0666
Mailing Address - Fax:404-888-0590
Practice Address - Street 1:650 HAMILTON AVE SE STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3778
Practice Address - Country:US
Practice Address - Phone:404-888-0666
Practice Address - Fax:404-888-0590
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor