Provider Demographics
NPI:1588717169
Name:SENNEBOGEN, JOSEPH JOHN SR (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:SENNEBOGEN
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:948 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4221
Mailing Address - Country:US
Mailing Address - Phone:770-514-7526
Mailing Address - Fax:770-424-1161
Practice Address - Street 1:3600 DALLAS HWY SW STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1631
Practice Address - Country:US
Practice Address - Phone:770-424-3331
Practice Address - Fax:770-424-1161
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBFPMedicare ID - Type UnspecifiedCHIROPRACTOR