Provider Demographics
NPI:1174672109
Name:SANTIAGO, NESEMIO (DC)
Entity Type:Individual
Prefix:
First Name:NESEMIO
Middle Name:
Last Name:SANTIAGO
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 1:544 RIVULETT CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5487
Mailing Address - Country:US
Mailing Address - Phone:770-921-1498
Mailing Address - Fax:770-921-6702
Practice Address - Street 1:880 INDIAN TRAIL LILBURN RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6844
Practice Address - Country:US
Practice Address - Phone:770-921-1498
Practice Address - Fax:770-921-6702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor