Healthcare Provider Details

I. General information

NPI: 1609749530
Provider Name (Legal Business Name): MILAGRO ABIGAIL VALLADARES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILAGRO ABIGAIL ESCOBAR DC

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5188 MANITU CT SW
LILBURN GA
30047-5329
US

IV. Provider business mailing address

5188 MANITU CT SW
LILBURN GA
30047-5329
US

V. Phone/Fax

Practice location:
  • Phone: 470-519-5270
  • Fax:
Mailing address:
  • Phone: 470-519-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: