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General NPI Number Information
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NPI Number | 1487157343
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Entity Type | Individual
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Provider Name | ADRIAN COLLAZO DC
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Gender | Male
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 1068 LAUREL VALLEY DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-3972
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Country | US
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Telephone | 787-918-5191
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Fax |
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Provider Business Mailing Address
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Address Line | 1068 LAUREL VALLEY DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-3972
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Country | US
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Telephone | 787-450-7199
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR010034
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License Number State | GA
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