Provider Demographics
NPI:1629800370
Name:RUIZ, AMANDA PAOLA (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:PAOLA
Last Name:RUIZ
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 1:4414 GLENRIDGE STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4932
Mailing Address - Country:US
Mailing Address - Phone:787-372-5669
Mailing Address - Fax:
Practice Address - Street 1:1544 SOUTHLAKE PKWY STE 9F
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3025
Practice Address - Country:US
Practice Address - Phone:678-505-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor