Healthcare Provider Details

I. General information

NPI: 1013836212
Provider Name (Legal Business Name): CARLOS SEBASTIAN ACEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 MARIETTA HWY STE 102
CANTON GA
30114-8207
US

IV. Provider business mailing address

2055 BARRETT LAKES BLVD NW APT 1022
KENNESAW GA
30144-8004
US

V. Phone/Fax

Practice location:
  • Phone: 770-580-0123
  • Fax:
Mailing address:
  • Phone: 939-274-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066725
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: