Provider Demographics
NPI:1891809497
Name:BELIZAIRE, MARCO A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:BELIZAIRE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1246 CONCORD RD SE # B
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4394
Mailing Address - Country:US
Mailing Address - Phone:770-434-5707
Mailing Address - Fax:413-383-6361
Practice Address - Street 1:1246 CONCORD RD SE # B
Practice Address - Street 2:SUITE 100
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4394
Practice Address - Country:US
Practice Address - Phone:770-434-5707
Practice Address - Fax:413-383-6361
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor