Provider Demographics
NPI:1336740166
Name:NIEVES BALAGUER, PAOLA ALEXANDRA (DC)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:ALEXANDRA
Last Name:NIEVES BALAGUER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 DELK RD SE APT 27D
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5374
Mailing Address - Country:US
Mailing Address - Phone:787-371-4529
Mailing Address - Fax:
Practice Address - Street 1:1503 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9112
Practice Address - Country:US
Practice Address - Phone:678-819-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor