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General NPI Number Information
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NPI Number | 1003761859
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Entity Type | Organization
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Legal Business Name | VITALISTIC WAVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 1600 PARKWOOD CIR SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-2147
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Country | US
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Telephone | 404-908-2150
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Fax | 770-264-3652
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Provider Business Mailing Address
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Address Line | 1600 PARKWOOD CIR SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-2147
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Country | US
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Telephone | 404-908-2150
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Fax | 770-264-3652
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICARDO ALBINO DIAZ
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Credential | DC
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Telephone | 787-585-9475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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