Provider Demographics
NPI:1215079686
Name:RENAISSANCE CHIROPRACTIC HEALTH CENTER INC
Entity type:Organization
Organization Name:RENAISSANCE CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-320-9626
Mailing Address - Street 1:8097 ROSWELL RD
Mailing Address - Street 2:BLD D
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350
Mailing Address - Country:US
Mailing Address - Phone:678-320-9626
Mailing Address - Fax:678-320-9686
Practice Address - Street 1:8097 ROSWELL RD
Practice Address - Street 2:BLD D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:678-320-9626
Practice Address - Fax:678-320-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCFDRMedicare ID - Type Unspecified
U69654Medicare UPIN