Provider Demographics
NPI:1174644033
Name:BISBY, DOUGLAS MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:BISBY
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 1:3220 143RD AVENUE CT W
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-4753
Mailing Address - Country:US
Mailing Address - Phone:309-716-8282
Mailing Address - Fax:
Practice Address - Street 1:483 JOHNNY MERCER BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2123
Practice Address - Country:US
Practice Address - Phone:912-897-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor