Provider Demographics
NPI:1043499726
Name:DESAULNIERS, VERONIQUE (DC)
Entity Type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:
Last Name:DESAULNIERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N JEFF DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1665
Mailing Address - Country:US
Mailing Address - Phone:770-719-8785
Mailing Address - Fax:
Practice Address - Street 1:560 N JEFF DAVIS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1665
Practice Address - Country:US
Practice Address - Phone:770-719-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHPNMedicare PIN
GAU60746Medicare UPIN