Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR010221 | GA |
NPI | 1245898345 |
---|---|
Provider Name | Edgardo J Salas-Robles |
First Address | Smyrna, GA 30080-8870 |
Second Address | Dalton, GA 30720-8213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 08/07/2019 |