Dynamic Spine and Sports Therapy

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

055355792 Issued in GA

Legal business name

DYNAMIC SPINE AND SPORTS THERAPY

Practice address

3400 Blue Springs Rd NW
Suite 100
Kennesaw, GA 30144-1079

Phone

(678) 674-5430

NPI assigned

Aug 21, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Jered Michael Hull, CHIROPRACTICNPI 1841439304

Title

Member

Phone

(678) 674-5430

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jered Michael Hull, DC, ATC, LAT

  • Chiropractor
  • Kennesaw, GA
  • NPI 1841439304
  Medicare reassignment NPD Authorized official
• Bailee Caroline Mims, DC

  • Chiropractor
  • Kennesaw, GA
  • NPI 1881384527
  Medicare reassignment NPD

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1659629723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 BLUE SPRINGS RD NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441079",
            "telephone_number": "678-674-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 BLUE SPRINGS RD NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441079",
            "telephone_number": "678-674-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC SPINE AND SPORTS THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-21",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "HULL",
        "authorized_official_first_name": "JERED",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "678-674-5430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CHIROPRACTIC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "055355792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Michael Durham
• Ronald Edward Durie Jr., DMD
• Anel Durmisevic
• Amber Duvall, M.ED, CCC-SLP
• Dventage LLC
• Dynamic Therapy Associates, Inc
• Dynamic Urgent Care PC
• E. Amanda Dellinger, LLC
• Gretchen Earwood
• Joanne T Eash, FNP-BC

• Chiropractor in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.