Provider Demographics
NPI:1467564559
Name:POOLE, BEVERLY JOY (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JOY
Last Name:POOLE
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:DR
Other - First Name:BEVERLY
Other - Middle Name:POOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHIROPRACTOR
Mailing Address - Street 1:1125 COUNTRY CLUB PL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5928
Mailing Address - Country:US
Mailing Address - Phone:404-313-2342
Mailing Address - Fax:
Practice Address - Street 1:1941 N ELM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2318
Practice Address - Country:US
Practice Address - Phone:706-335-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHSFMedicare ID - Type Unspecified
GAV00140Medicare UPIN