Provider Demographics
NPI:1447280896
Name:DIETZ, RICHARD A (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:DIETZ
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 1:3525 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2410
Mailing Address - Country:US
Mailing Address - Phone:770-614-9599
Mailing Address - Fax:770-614-9597
Practice Address - Street 1:3525 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2410
Practice Address - Country:US
Practice Address - Phone:770-614-9599
Practice Address - Fax:770-614-9597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGZZOtherMEDICARE
GA35ZCGZZOtherMEDICARE