Provider Demographics
NPI:1831858679
Name:DELGADO RIVERA, CORALIS (DC)
Entity type:Individual
Prefix:DR
First Name:CORALIS
Middle Name:
Last Name:DELGADO RIVERA
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 1:2810 COBB LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2003
Mailing Address - Country:US
Mailing Address - Phone:770-436-5712
Mailing Address - Fax:770-436-1215
Practice Address - Street 1:2810 COBB LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2003
Practice Address - Country:US
Practice Address - Phone:770-436-5712
Practice Address - Fax:770-436-1215
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty