Provider Demographics
NPI:1427121193
Name:ENIX, DALE E (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:ENIX
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 1:240 CHEROKEE ST NE STE 302
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1628
Mailing Address - Country:US
Mailing Address - Phone:770-955-3502
Mailing Address - Fax:770-874-7753
Practice Address - Street 1:736 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1860
Practice Address - Country:US
Practice Address - Phone:770-955-3502
Practice Address - Fax:770-874-7753
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU76346Medicare UPIN
GA35ZCGMGMedicare ID - Type Unspecified