Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | CHIRO006625 | GA |
Y | 111NS0005X | Chiropractic Sports Physician | CHIR006625 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIRO006625 | GA |
NPI | 1417136797 |
---|---|
Provider Name | Dr. Michal J Nesnick |
First Address | Woodstock, GA 30189 |
Second Address | Woodstock, GA 30189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2007 |
Last Update Date | 08/06/2017 |