Individual
DR. DOUGLAS A LAROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2538 CEDARCREST RD, STE. 113, ACWORTH, GA 30101-8293
(770) 222-7555
(770) 222-1919
Mailing address
2538 CEDARCREST RD, STE. 113, ACWORTH, GA 30101-8293
(770) 222-7555
(770) 222-1919
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6046
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198-09-00-VL
GEORGIA STATE TAX ID
GA
01
—
58-2659125
FEDERAL TAX ID
GA
Enumeration date
10/12/2006
Last updated
08/30/2016
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