Provider Demographics
NPI:1912990300
Name:SALLARULO, PATRICK JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:SALLARULO
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 1:5742 REVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1429
Mailing Address - Country:US
Mailing Address - Phone:770-446-6571
Mailing Address - Fax:
Practice Address - Street 1:2896 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4009
Practice Address - Country:US
Practice Address - Phone:770-457-0584
Practice Address - Fax:770-457-0773
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-1742220OtherTAX ID NUMBER
GAU17302Medicare UPIN