Healthcare Provider Details

I. General information

NPI: 1598833634
Provider Name (Legal Business Name): CLYDE EMIR NAVARRO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 S PARK ST SUITE 102
CARROLLTON GA
30117-3825
US

IV. Provider business mailing address

775 S PARK ST SUITE 102
CARROLLTON GA
30117-3825
US

V. Phone/Fax

Practice location:
  • Phone: 678-485-3155
  • Fax:
Mailing address:
  • Phone: 678-485-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number380
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR008718
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIR008718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: