Provider Demographics
NPI:1578863379
Name:BLAIR, MONICA DORETHA (DC)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:DORETHA
Last Name:BLAIR
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 1:4123 HIGHLAND PARC PL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-2407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1869 STONE MOUNTAIN LITHONIA RD
Practice Address - Street 2:SUITE E
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3531
Practice Address - Country:US
Practice Address - Phone:678-458-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor