Provider Demographics
NPI:1538210075
Name:DAVID J PASQUARIELLO DC PC
Entity type:Organization
Organization Name:DAVID J PASQUARIELLO DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PASQUARIELLO
Authorized Official - Suffix:I
Authorized Official - Credentials:D C
Authorized Official - Phone:770-944-2100
Mailing Address - Street 1:6135 MABLETON PKWY SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-4345
Mailing Address - Country:US
Mailing Address - Phone:770-944-2100
Mailing Address - Fax:770-944-0253
Practice Address - Street 1:6135 MABLETON PKWY SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-4345
Practice Address - Country:US
Practice Address - Phone:770-944-2100
Practice Address - Fax:770-944-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22536Medicare UPIN