Provider Demographics
NPI:1568509545
Name:MINICOZZI, SALVATORE JOSEPH (DC, CCEP)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:MINICOZZI
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:5871 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5375
Mailing Address - Country:US
Mailing Address - Phone:404-531-9525
Mailing Address - Fax:404-531-9842
Practice Address - Street 1:5871 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 115
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5375
Practice Address - Country:US
Practice Address - Phone:404-531-9525
Practice Address - Fax:404-531-9842
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA005349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU-57154Medicare UPIN
GA35ZCGXRMedicare ID - Type Unspecified