Provider Demographics
NPI:1952501090
Name:DR NANCI L BISHOP DC PC
Entity Type:Organization
Organization Name:DR NANCI L BISHOP DC PC
Other - Org Name:DOUGLASVILLE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-949-1900
Mailing Address - Street 1:5908 FAIRBURN RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2303
Mailing Address - Country:US
Mailing Address - Phone:770-949-1900
Mailing Address - Fax:770-949-7751
Practice Address - Street 1:5908 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2303
Practice Address - Country:US
Practice Address - Phone:770-949-1900
Practice Address - Fax:770-949-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5014Medicare UPIN