Provider Demographics
NPI:1538234851
Name:LYNN, JAROD D (DC)
Entity type:Individual
Prefix:DR
First Name:JAROD
Middle Name:D
Last Name:LYNN
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:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-0004
Mailing Address - Country:US
Mailing Address - Phone:770-516-5552
Mailing Address - Fax:
Practice Address - Street 1:4200 WADE GREEN RD NW
Practice Address - Street 2:SUITE 27
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1237
Practice Address - Country:US
Practice Address - Phone:770-516-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHBWMedicare ID - Type Unspecified
U93398Medicare UPIN