Provider Demographics
NPI:1124260781
Name:IRACI, CYNTHIA LOUISE (DC)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:IRACI
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 1:235 WALESKA RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2428
Mailing Address - Country:US
Mailing Address - Phone:770-479-9784
Mailing Address - Fax:
Practice Address - Street 1:235 WALESKA RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2428
Practice Address - Country:US
Practice Address - Phone:770-479-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor