Provider Demographics
NPI:1043580244
Name:TRUJILLO ATLAS ORTHOGONAL CHIROPRACTIC, P. C.
Entity Type:Organization
Organization Name:TRUJILLO ATLAS ORTHOGONAL CHIROPRACTIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:770-495-3444
Mailing Address - Street 1:2800 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7912
Mailing Address - Country:US
Mailing Address - Phone:770-495-3444
Mailing Address - Fax:770-495-3888
Practice Address - Street 1:2800 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7912
Practice Address - Country:US
Practice Address - Phone:770-495-3444
Practice Address - Fax:770-495-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G700111Medicare PIN