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General NPI Number Information
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NPI Number | 1245898345
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Entity Type | Individual
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Provider Name | EDGARDO J SALAS-ROBLES DC
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 715 S THORNTON AVE
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City | DALTON
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State | GA
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Zip | 30720-8213
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Country | US
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Telephone | 706-609-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 2157 LAKE PARK DR SE
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City | SMYRNA
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State | GA
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Zip | 30080-8870
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Country | US
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Telephone | 404-518-0052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIR010221
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License Number State | GA
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