Provider Demographics
NPI:1780155861
Name:INOUE, DAISUKE (DC)
Entity type:Individual
Prefix:
First Name:DAISUKE
Middle Name:
Last Name:INOUE
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 1:5000 WINTERS CHAPEL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1746
Mailing Address - Country:US
Mailing Address - Phone:770-557-0706
Mailing Address - Fax:470-299-5168
Practice Address - Street 1:5000 WINTERS CHAPEL RD STE 1
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30360-1746
Practice Address - Country:US
Practice Address - Phone:770-557-0706
Practice Address - Fax:470-299-5168
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR010155OtherCHIROPRACTIC LICENSURE