Individual
GUSTAVO ANDRE PEREZ CABALLERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, DC, GTS
Contact information
Practice address
1379 IRIS DR SE, CONYERS, GA 30013-1768
(404) 964-4985
Mailing address
3360 STEVE REYNOLDS BLVD APT 2411, DULUTH, GA 30096-4588
(470) 421-1225
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CHIR010551
GA
111NR0400X
Rehabilitation Chiropractor
Primary
CHIR010551
GA
111NS0005X
Sports Physician Chiropractor
CHIR010551
GA
111NX0800X
Orthopedic Chiropractor
CHIR010551
GA
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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