Healthcare Provider Details

I. General information

NPI: 1922756725
Provider Name (Legal Business Name): YADIEL BELLO ROMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 POWDER SPRINGS RD SW STE 210
MARIETTA GA
30064-4570
US

IV. Provider business mailing address

2453 POWDER SPRINGS RD SW STE 210
MARIETTA GA
30064-4570
US

V. Phone/Fax

Practice location:
  • Phone: 678-567-2313
  • Fax: 855-771-9101
Mailing address:
  • Phone: 678-567-2313
  • Fax: 855-771-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010732
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: