MEDICARE: DR. BIANCA KAITLYN OLDERSHAW D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR010069	GA

General Provider Information

NPI Number	:	1356834790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIANCA KAITLYN OLDERSHAW D.C.

Provider Business Mailing Address
First Line	:	225 FRANKLIN RD UNIT 4407
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2794
Country	:	US
Telephone Number	:	570-574-4152
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 FRANKLIN RD UNIT 4407
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2794
Country	:	US
Telephone Number	:	570-574-4152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	05/31/2024

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