Provider Demographics
NPI:1134121973
Name:MOON, NANCI B (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCI
Middle Name:B
Last Name:MOON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NANCI
Other - Middle Name:LEE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5908 FAIRBURN RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134
Mailing Address - Country:US
Mailing Address - Phone:770-949-1900
Mailing Address - Fax:770-949-7751
Practice Address - Street 1:5908 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-949-1900
Practice Address - Fax:770-949-7751
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR 001200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP5014Medicare UPIN