Individual provider Active NPI

Enrique Crespo, D.C.

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1396883872
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR006889 Issued in GA
Practice address
596 Seminole Dr NE
Marietta, GA 30060-1508
Phone
(770) 428-4909
Fax
(770) 428-0903
NPI assigned
Feb 5, 2007
Last updated
Jul 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR006889 GA Primary

Addresses

Primary practice location

596 Seminole Dr NE
Marietta, GA 30060-1508

Mailing address

596 Seminole Dr NE
Marietta, GA 30060-1508
Phone (770) 428-4909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Medical of Georgia, LLC CurrentSince Dec 16, 2020 Accepting new patients
Marietta Chiropractic Clinic,LLC PastSince Dec 16, 2020 Accepting new patients
Edward D Schneider, DC, PC Chiropractor PastSince Oct 1, 2002 Accepting new patients

Locations

596 Seminole Dr NE
Marietta, GA 30060
Phone (770) 427-9046

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595548800000",
    "number": "1396883872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 SEMINOLE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601508",
            "telephone_number": "770-428-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 SEMINOLE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601508",
            "telephone_number": "770-428-4909",
            "fax_number": "770-428-0903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRESPO",
        "first_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR006889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.