Provider Demographics
NPI:1962679340
Name:JORGE A. BUENO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JORGE A. BUENO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-386-0222
Mailing Address - Street 1:1350 JOE FRANK HARRIS PKWY SE STE 102
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-4202
Mailing Address - Country:US
Mailing Address - Phone:770-386-0222
Mailing Address - Fax:
Practice Address - Street 1:1350 JOE FRANK HARRIS PKWY SE STE 102
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-4202
Practice Address - Country:US
Practice Address - Phone:770-386-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007057111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHNHMedicare PIN