Provider Demographics
NPI:1053038091
Name:BETANCOURT O'FARRILL, ALEJANDRO (DC)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:BETANCOURT O'FARRILL
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 1:5430 N HENRY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3270
Mailing Address - Country:US
Mailing Address - Phone:770-389-4744
Mailing Address - Fax:
Practice Address - Street 1:5430 N HENRY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3270
Practice Address - Country:US
Practice Address - Phone:770-389-4744
Practice Address - Fax:770-389-4760
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor