Provider Demographics
NPI:1932396462
Name:SANTOS, WILLARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:
Last Name:SANTOS
Suffix:JR
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 1:2537 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3515
Mailing Address - Country:US
Mailing Address - Phone:770-823-2860
Mailing Address - Fax:770-458-1558
Practice Address - Street 1:2537 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3515
Practice Address - Country:US
Practice Address - Phone:770-823-2860
Practice Address - Fax:770-458-1558
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor