Provider Demographics
NPI:1720018583
Name:BROOKSHER, DEANA M (DC)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:M
Last Name:BROOKSHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:M
Other - Last Name:GUADAGNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:59 GARLAND BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:SAUTEE NACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:30571-2702
Mailing Address - Country:US
Mailing Address - Phone:706-878-1420
Mailing Address - Fax:706-878-1420
Practice Address - Street 1:59 GARLAND BRISTOL RD
Practice Address - Street 2:
Practice Address - City:SAUTEE NACOOCHEE
Practice Address - State:GA
Practice Address - Zip Code:30571-2702
Practice Address - Country:US
Practice Address - Phone:706-878-1420
Practice Address - Fax:706-878-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV01537Medicare UPIN
GA35ZCHWDMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER