Provider Demographics
NPI:1922267665
Name:BISHOP, JEREMY WALTER (MS, DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WALTER
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BAKER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2134
Mailing Address - Country:US
Mailing Address - Phone:678-673-6552
Mailing Address - Fax:
Practice Address - Street 1:20 BAKER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2134
Practice Address - Country:US
Practice Address - Phone:678-673-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008317111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation