Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 380 | PR |
N | 111NP0017X | Pediatric Chiropractor | CHIR008718 | GA |
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR008718 | GA |
NPI | 1598833634 |
---|---|
Provider Name | Dr. Clyde Emir Navarro |
First Address | Carrollton, GA 30117-3825 |
Second Address | Carrollton, GA 30117-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 17/04/2013 |