Provider Demographics
NPI:1871653279
Name:JEAN-LOUIS, CLAREL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CLAREL
Middle Name:
Last Name:JEAN-LOUIS
Suffix:JR
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 1:1257 COMMERCIAL DR SW STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5991
Mailing Address - Country:US
Mailing Address - Phone:770-761-2181
Mailing Address - Fax:770-761-0221
Practice Address - Street 1:1257 COMMERCIAL DR SW STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5991
Practice Address - Country:US
Practice Address - Phone:770-761-2181
Practice Address - Fax:770-761-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU89939Medicare UPIN
GA35ZCGTNMedicare ID - Type Unspecified