Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIR007319 | GA |
NPI | 1336299858 |
---|---|
Provider Name | Dr. David R. Perez |
First Address | Marietta, GA 30066-6012 |
Second Address | Marietta, GA 30066-6012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |