Provider Demographics
NPI:1215209697
Name:HEAIRLSTON, DEBORAH ENTWISTLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ENTWISTLE
Last Name:HEAIRLSTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3417 CANTON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2896
Mailing Address - Country:US
Mailing Address - Phone:770-424-5551
Mailing Address - Fax:770-424-5553
Practice Address - Street 1:3417 CANTON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2896
Practice Address - Country:US
Practice Address - Phone:770-424-5551
Practice Address - Fax:770-424-5553
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor