Provider Demographics
NPI:1710156427
Name:NESFAMCHIRO,LLC
Entity Type:Organization
Organization Name:NESFAMCHIRO,LLC
Other - Org Name:NESNICK FAMILY AND SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-516-2323
Mailing Address - Street 1:2230 TOWNE LAKE PKWY
Mailing Address - Street 2:BUILDING 200 SUITE 110
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5540
Mailing Address - Country:US
Mailing Address - Phone:770-516-2323
Mailing Address - Fax:770-516-2308
Practice Address - Street 1:2230 TOWNE LAKE PKWY
Practice Address - Street 2:BUILDING 200 SUITE 110
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:770-516-2323
Practice Address - Fax:770-516-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700279Medicare PIN