Healthcare Provider Details

I. General information

NPI: 1114220423
Provider Name (Legal Business Name): CHRISTOPHER AMBROSIO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7834
US

IV. Provider business mailing address

216 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7834
US

V. Phone/Fax

Practice location:
  • Phone: 678-445-2746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006021
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: