Provider Demographics
NPI:1679036222
Name:ACEVEDO, AMADIS (DC)
Entity Type:Individual
Prefix:
First Name:AMADIS
Middle Name:
Last Name:ACEVEDO
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 1:295 MOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3760
Mailing Address - Country:US
Mailing Address - Phone:770-926-4646
Mailing Address - Fax:888-342-7278
Practice Address - Street 1:295 MOLLY LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3760
Practice Address - Country:US
Practice Address - Phone:770-926-4646
Practice Address - Fax:888-342-7278
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor