Provider Demographics
NPI:1720497852
Name:CROFT, MIRIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:CROFT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 PIERCE DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2411
Mailing Address - Country:US
Mailing Address - Phone:770-452-2955
Mailing Address - Fax:770-676-7237
Practice Address - Street 1:3652 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:STE 1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-2120
Practice Address - Country:US
Practice Address - Phone:770-452-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor