Healthcare Provider Details

I. General information

NPI: 1720018583
Provider Name (Legal Business Name): DEANA M BROOKSHER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANA M GUADAGNO DC

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 GARLAND BRISTOL RD
SAUTEE NACOOCHEE GA
30571-2702
US

IV. Provider business mailing address

59 GARLAND BRISTOL RD
SAUTEE NACOOCHEE GA
30571-2702
US

V. Phone/Fax

Practice location:
  • Phone: 706-878-1420
  • Fax: 706-878-1420
Mailing address:
  • Phone: 706-878-1420
  • Fax: 706-878-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6001
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: