Healthcare Provider Details

I. General information

NPI: 1104159342
Provider Name (Legal Business Name): DAYMA ROSELLO-RIVERA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CARPENTER DR NE SUITE 209
ATLANTA GA
30328-4928
US

IV. Provider business mailing address

275 CARPENTER DR NE SUITE 209
ATLANTA GA
30328-4928
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-4410
  • Fax: 404-781-4410
Mailing address:
  • Phone: 404-255-4410
  • Fax: 404-781-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR007606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: