Healthcare Provider Details

I. General information

NPI: 1912990300
Provider Name (Legal Business Name): PATRICK JOSEPH SALLARULO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2896 CHAMBLEE TUCKER RD SUITE 4
ATLANTA GA
30341-4009
US

IV. Provider business mailing address

5742 REVINGTON DR
NORCROSS GA
30092-1429
US

V. Phone/Fax

Practice location:
  • Phone: 770-457-0584
  • Fax: 770-457-0773
Mailing address:
  • Phone: 770-446-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2472
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: