Provider Demographics
NPI:1366002412
Name:MARRERO-SANCHEZ, CARLA MICHELLE (DC,)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MICHELLE
Last Name:MARRERO-SANCHEZ
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 1:875 FRANKLIN GTWY SE APT 533
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-2922
Mailing Address - Country:US
Mailing Address - Phone:787-449-8263
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD STE H6
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5023
Practice Address - Country:US
Practice Address - Phone:678-352-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10204111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty