Provider Demographics
NPI:1508567215
Name:ZAVALA, AJ CHIA-YUEN (DC)
Entity Type:Individual
Prefix:
First Name:AJ
Middle Name:CHIA-YUEN
Last Name:ZAVALA
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 1:1161 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3411
Mailing Address - Country:US
Mailing Address - Phone:858-353-8384
Mailing Address - Fax:
Practice Address - Street 1:3000 JOHNSON FERRY RD STE 102
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5697
Practice Address - Country:US
Practice Address - Phone:678-395-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor