Provider Demographics
NPI:1538406756
Name:KEYSTONE CHIROPRACTIC ASSOCIATES OF NEWNAN, LLC
Entity type:Organization
Organization Name:KEYSTONE CHIROPRACTIC ASSOCIATES OF NEWNAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DC
Authorized Official - Phone:678-673-6552
Mailing Address - Street 1:20 BAKER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2134
Mailing Address - Country:US
Mailing Address - Phone:678-673-6552
Mailing Address - Fax:678-673-6550
Practice Address - Street 1:20 BAKER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2134
Practice Address - Country:US
Practice Address - Phone:678-673-6552
Practice Address - Fax:678-673-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008317111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty