Provider Demographics
NPI:1174394282
Name:CORREA, LUIS OSVALDO (DC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:OSVALDO
Last Name:CORREA
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 1:1050 HOWELL MILL RD NW APT 631
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6196
Mailing Address - Country:US
Mailing Address - Phone:787-342-8350
Mailing Address - Fax:
Practice Address - Street 1:1050 HOWELL MILL RD NW APT 631
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6196
Practice Address - Country:US
Practice Address - Phone:787-342-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor