Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR005475 | GA |
NPI | 1003996026 |
---|---|
Provider Name | Cadice Shepherd |
First Address | Kennesaw, GA 30144-1966 |
Second Address | Kennesaw, GA 30144-1966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |