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General NPI Number Information
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NPI Number | 1265746051
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Entity Type | Organization
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Legal Business Name | DESHAW FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 664 SCRANTON RD SUITE 222
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City | BRUNSWICK
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State | GA
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Zip | 31520-1945
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Country | US
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Telephone | 912-264-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 664 SCRANTON RD SUITE 222
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City | BRUNSWICK
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State | GA
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Zip | 31520-1945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BRENT DESHAW
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Credential | D.C.
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Telephone | 912-264-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR008476
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License Number State | GA
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