Provider Demographics
NPI:1952471781
Name:GUERRESO, RICHARD A (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:GUERRESO
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 1:2014 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2625
Mailing Address - Country:US
Mailing Address - Phone:770-995-6789
Mailing Address - Fax:770-995-7832
Practice Address - Street 1:2014 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2625
Practice Address - Country:US
Practice Address - Phone:770-995-6789
Practice Address - Fax:770-995-7832
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
502606OtherBCBS OF GA
5049OtherGA LISCENSE #
GA35CZCCWCMedicare PIN