Provider Demographics
NPI:1659329035
Name:ALVAREZ, JOSE ANTONIO (DC, CCSMP)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:DC, CCSMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 FLAT SHOALS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6525
Mailing Address - Country:US
Mailing Address - Phone:404-241-5304
Mailing Address - Fax:404-241-9388
Practice Address - Street 1:3424 FLAT SHOALS RD
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6525
Practice Address - Country:US
Practice Address - Phone:404-241-5304
Practice Address - Fax:404-241-9388
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5496111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00970912AMedicaid
GA00970912AMedicaid
GAU65322Medicare UPIN