Provider Demographics
NPI:1417136797
Name:NESNICK, MICHAL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:J
Last Name:NESNICK
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 1:1025 ROSE CREEK DR
Mailing Address - Street 2:STE 340
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-516-2323
Mailing Address - Fax:770-516-2219
Practice Address - Street 1:1025 ROSE CREEK DR
Practice Address - Street 2:STE 340
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-516-2323
Practice Address - Fax:770-516-2219
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006625111NS0005X
GACHIRO006625111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5111350029Medicare PIN