Provider Demographics
NPI:1265746051
Name:DESHAW FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DESHAW FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-264-2244
Mailing Address - Street 1:664 SCRANTON RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:664 SCRANTON RD
Practice Address - Street 2:SUITE 222
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1945
Practice Address - Country:US
Practice Address - Phone:912-264-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty