Provider Demographics
NPI:1144645383
Name:WRIGHT, SHANIQUA A (DC)
Entity type:Individual
Prefix:DR
First Name:SHANIQUA
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BRYSON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5920
Mailing Address - Country:US
Mailing Address - Phone:813-785-7422
Mailing Address - Fax:
Practice Address - Street 1:710 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2623
Practice Address - Country:US
Practice Address - Phone:678-459-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor