Provider Demographics
NPI:1245357466
Name:DR EDDY R NESTLE D C INC
Entity type:Organization
Organization Name:DR EDDY R NESTLE D C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NESTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-445-6007
Mailing Address - Street 1:273 MACLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5052
Mailing Address - Country:US
Mailing Address - Phone:770-445-6007
Mailing Address - Fax:770-445-6008
Practice Address - Street 1:273 MACLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5052
Practice Address - Country:US
Practice Address - Phone:770-445-6007
Practice Address - Fax:770-445-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
385541541AMedicare ID - Type Unspecified