Provider Demographics
NPI:1215330113
Name:GIROUSH, GAMAL F (DC)
Entity type:Individual
Prefix:DR
First Name:GAMAL
Middle Name:F
Last Name:GIROUSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 WILLEO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5084
Mailing Address - Country:US
Mailing Address - Phone:770-212-9414
Mailing Address - Fax:678-404-5479
Practice Address - Street 1:9410 WILLEO RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5084
Practice Address - Country:US
Practice Address - Phone:770-212-9414
Practice Address - Fax:678-404-5479
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor