Provider Demographics
NPI:1831521582
Name:FARLESS, DEANNA DEJESUS (DC)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:DEJESUS
Last Name:FARLESS
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 1:2323 SHALLOWFORD RD
Mailing Address - Street 2:STE105C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2000
Mailing Address - Country:US
Mailing Address - Phone:770-657-7463
Mailing Address - Fax:
Practice Address - Street 1:2323 SHALLOWFORD RD
Practice Address - Street 2:STE105C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2000
Practice Address - Country:US
Practice Address - Phone:770-657-7463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009096111N00000X
MI2301010244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor