Provider Demographics
NPI:1457819484
Name:100 PERCENT CHIROPRACTIC ORTIZ VALLE LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC ORTIZ VALLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-343-3304
Mailing Address - Street 1:1585 CHURCH ST STE 665
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6059
Mailing Address - Country:US
Mailing Address - Phone:404-913-6734
Mailing Address - Fax:
Practice Address - Street 1:1585 CHURCH ST STE 665
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6059
Practice Address - Country:US
Practice Address - Phone:404-913-6734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty