Provider Demographics
NPI:1962718098
Name:FORAN, TATYANA SHAVERDINA (DC)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:SHAVERDINA
Last Name:FORAN
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 1:3778 SOUTHWICK CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5406
Mailing Address - Country:US
Mailing Address - Phone:770-833-7964
Mailing Address - Fax:770-671-8002
Practice Address - Street 1:1370 CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4132
Practice Address - Country:US
Practice Address - Phone:404-590-3922
Practice Address - Fax:770-671-8002
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor