Provider Demographics
NPI:1962543066
Name:PORTER, DEBRA A (DC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:PORTER
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 1:2655 DALLAS HWY SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2597
Mailing Address - Country:US
Mailing Address - Phone:770-427-1889
Mailing Address - Fax:770-427-7513
Practice Address - Street 1:2655 DALLAS HWY SW
Practice Address - Street 2:SUITE 110
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2597
Practice Address - Country:US
Practice Address - Phone:770-427-1889
Practice Address - Fax:770-427-7513
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA646983OtherAMERICAN CHIROPRACTIC NET
GA52650137OtherBLUECROSSBLUESHIELD OF GA
GA5707692OtherAETNA
GA1001532OtherAM.SPECIALTY NETWORK
GAGRP3129Medicare ID - Type Unspecified