=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245357466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR EDDY R NESTLE D C INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 273 MACLAND RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30132-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-445-6007
-----------------------------------------------------
Fax | 770-445-6008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 273 MACLAND RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30132-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-445-6007
-----------------------------------------------------
Fax | 770-445-6008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. EDDY R NESTLE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 770-445-6007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1546
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------