Provider Demographics
NPI:1942428727
Name:NOVA CHIROPRACTIC SERVICES
Entity Type:Organization
Organization Name:NOVA CHIROPRACTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTORO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-248-8499
Mailing Address - Street 1:305 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-3911
Mailing Address - Country:US
Mailing Address - Phone:229-248-8499
Mailing Address - Fax:229-248-1595
Practice Address - Street 1:305 S WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-3911
Practice Address - Country:US
Practice Address - Phone:229-248-8499
Practice Address - Fax:229-248-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFCVMedicare ID - Type Unspecified
GAU707023Medicare UPIN