Provider Demographics
NPI:1992902357
Name:PICCIRILLO, DANA G (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:G
Last Name:PICCIRILLO
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 1:2181 NORTHLAKE PWKY
Mailing Address - Street 2:BUILDING 6 SUITE 120
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-934-4233
Mailing Address - Fax:770-934-4234
Practice Address - Street 1:2181 NORTHLAKE PKWY
Practice Address - Street 2:BUILDING 6 SUITE 120
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4107
Practice Address - Country:US
Practice Address - Phone:770-934-4233
Practice Address - Fax:770-934-4234
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007460111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation