Healthcare Provider Details

I. General information

NPI: 1326967845
Provider Name (Legal Business Name): EUNNA LACERDA JESUS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11285 ELKINS RD UNIT K-1
ROSWELL GA
30076-1259
US

IV. Provider business mailing address

36 WILLOW DR
DALLAS GA
30157-6637
US

V. Phone/Fax

Practice location:
  • Phone: 770-640-9145
  • Fax:
Mailing address:
  • Phone: 732-610-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number66724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: