Active NPI
Daniel Patric Fortin, DC
- Chiropractor
- Conyers, GA
National Provider Identifier
1942486501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1411
- Practice address
- 1003 E Freeway Dr SE
Conyers, GA 30094-5927 - Phone
- (770) 760-0060
- Fax
- (770) 760-0409
- NPI assigned
- Jan 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1411 | GA | Primary |
Addresses
Primary practice location
1003 E Freeway Dr SE
Conyers, GA 30094-5927
Mailing address
1003 E Freeway Dr SE
Conyers, GA 30094-5927
Phone (770) 760-0060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00395570 | Other | GA | MEDICARE RAILROAD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1411 | GA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204502400000",
"number": "1942486501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 E FREEWAY DR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300945927",
"telephone_number": "770-760-0060",
"fax_number": "770-760-0409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 E FREEWAY DR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300945927",
"telephone_number": "770-760-0060",
"fax_number": "770-760-0409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTIN",
"first_name": "DANIEL",
"middle_name": "PATRIC",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-14",
"last_updated": "2008-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "GA",
"license": "1411",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00395570",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.