Provider Demographics
NPI:1417049172
Name:PRESTON, ELBONIE N (DC)
Entity Type:Individual
Prefix:DR
First Name:ELBONIE
Middle Name:N
Last Name:PRESTON
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 1:5336 EAST MOUNTAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6431
Mailing Address - Country:US
Mailing Address - Phone:678-884-3778
Mailing Address - Fax:866-810-3847
Practice Address - Street 1:5336 EAST MOUNTAIN STREET
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-6431
Practice Address - Country:US
Practice Address - Phone:678-884-3778
Practice Address - Fax:866-810-3847
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor