Organization
FORTIN CHIROPRACTIC & ATHLETIC HEALTH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL P. FORTIN DC (CEO)
(770) 760-0060
Entity
Organization
Contact information
Practice address
1003 E FREEWAY DR SE, CONYERS, GA 30094-5927
(770) 760-0060
(770) 760-0409
Mailing address
1003 E FREEWAY DR SE, CONYERS, GA 30094-5927
(770) 760-0060
(770) 760-0409
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1411
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG7126
MEDICARE RAILROAD
GA
Enumeration date
08/21/2006
Last updated
04/08/2008
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