Provider Demographics
NPI:1356834790
Name:OLDERSHAW, BIANCA KAITLYN (DC)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:KAITLYN
Last Name:OLDERSHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 FRANKLIN RD UNIT 4407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2794
Mailing Address - Country:US
Mailing Address - Phone:570-574-4152
Mailing Address - Fax:
Practice Address - Street 1:225 FRANKLIN RD UNIT 4407
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2794
Practice Address - Country:US
Practice Address - Phone:570-574-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor