Provider Demographics
NPI:1487157343
Name:COLLAZO, ADRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:
Last Name:COLLAZO
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 1:1068 LAUREL VALLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3972
Mailing Address - Country:US
Mailing Address - Phone:787-450-7199
Mailing Address - Fax:
Practice Address - Street 1:1068 LAUREL VALLEY DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3972
Practice Address - Country:US
Practice Address - Phone:787-918-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty