# DYNAMIC SPINE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699174896
- **Authorized official:** DR. DUSTIN R WALTON D.C. (CO OWNER/ CLINICAL DIRECTOR)
- **Authorized official phone:** (770) 742-9801

## Contact information

- **Practice address:** 2836 HIGHWAY 54, SUITE 2836, PEACHTREE CITY, GA 30269-1026
- **Practice address phone:** (770) 742-9801
- **Mailing address:** 2836 HIGHWAY 54, SUITE 2836, PEACHTREE CITY, GA 30269-1026
- **Mailing address phone:** (770) 742-9801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | CHIR009256 | GA | Yes |
| 111NS0005X | Sports Physician Chiropractor | CHIR009256 | GA | — |

## Other

- **Enumeration date:** 08/14/2014
- **Last updated:** 08/14/2014