Provider Demographics
NPI:1114550209
Name:PACHECO, GUADALUPE ROSARIO (DC)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:ROSARIO
Last Name:PACHECO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 DELAMERE LN
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1250
Mailing Address - Country:US
Mailing Address - Phone:678-499-1377
Mailing Address - Fax:
Practice Address - Street 1:4292 MEMORIAL DR STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1224
Practice Address - Country:US
Practice Address - Phone:470-437-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor