Individual provider Active NPI

Sandy Junior Rodriguez de Jesus, DC

  • Chiropractor
  • Lawrenceville, GA
National Provider Identifier
1619757770
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR011079 Issued in GA
Practice address
1848 Old Norcross Rd Ste A400
Lawrenceville, GA 30044-2311
Phone
(678) 205-5546
Fax
(678) 226-1034
NPI assigned
Oct 4, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR011079 GA Primary

Addresses

Primary practice location

1848 Old Norcross Rd Ste A400
Lawrenceville, GA 30044-2311

Mailing address

1848 Old Norcross Rd Ste A400
Lawrenceville, GA 30044-2311
Phone (678) 205-5546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CHIR011079GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
TN Chiropractic Clinic, LLC Chiropractor PastSince Sep 21, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1619757770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 OLD NORCROSS RD STE A400",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442311",
            "telephone_number": "678-205-5546",
            "fax_number": "678-226-1034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 OLD NORCROSS RD STE A400",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442311",
            "telephone_number": "678-205-5546",
            "fax_number": "678-226-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ DE JESUS",
        "first_name": "SANDY",
        "middle_name": "JUNIOR",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-04",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR011079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.