Provider Demographics
NPI:1386772861
Name:JAJAL, JUTHIKA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JUTHIKA
Middle Name:MARIE
Last Name:JAJAL
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 1:1819 ASHBOROUGH CIR SE APT D
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6914
Mailing Address - Country:US
Mailing Address - Phone:404-769-1146
Mailing Address - Fax:
Practice Address - Street 1:12926 HIGHWAY 92
Practice Address - Street 2:SUITE 900
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5195
Practice Address - Country:US
Practice Address - Phone:678-388-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor