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General NPI Number Information
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NPI Number | 1538406756
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Entity Type | Organization
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Legal Business Name | KEYSTONE CHIROPRACTIC ASSOCIATES OF NEWNAN, LLC
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 20 BAKER RD SUITE 2
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City | NEWNAN
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State | GA
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Zip | 30265-2134
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Country | US
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Telephone | 678-673-6552
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Fax | 678-673-6550
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Provider Business Mailing Address
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Address Line | 20 BAKER RD SUITE 2
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City | NEWNAN
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State | GA
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Zip | 30265-2134
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Country | US
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Telephone | 678-673-6552
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Fax | 678-673-6550
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. JEREMY WALTER BISHOP
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Credential | M.S., D.C.
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Telephone | 678-673-6552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 008317
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License Number State | GA
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