Healthcare Provider Details

I. General information

NPI: 1508567215
Provider Name (Legal Business Name): AJ CHIA-YUEN ZAVALA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 ROSWELL RD STE 321-B
MARIETTA GA
30062-2997
US

IV. Provider business mailing address

1161 BAKER LN
MARIETTA GA
30062-3411
US

V. Phone/Fax

Practice location:
  • Phone: 404-369-3833
  • Fax:
Mailing address:
  • Phone: 858-353-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: