Provider Demographics
NPI:1205290558
Name:PURO, SHAUN (DC)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:PURO
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 1:8800 ROSWELL RD STE A-235
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1826
Mailing Address - Country:US
Mailing Address - Phone:770-641-9797
Mailing Address - Fax:770-641-9771
Practice Address - Street 1:8800 ROSWELL RD STE A-235
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-1826
Practice Address - Country:US
Practice Address - Phone:770-641-9797
Practice Address - Fax:770-641-9771
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor