Provider Demographics
NPI:1336277813
Name:ACOSTA, RENE' RUBEN (DC)
Entity type:Individual
Prefix:DR
First Name:RENE'
Middle Name:RUBEN
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 PEACHTREE RD NE APT 701
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1337
Mailing Address - Country:US
Mailing Address - Phone:404-397-9911
Mailing Address - Fax:
Practice Address - Street 1:236 JOHNSON FERRY RD NE STE 200
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3869
Practice Address - Country:US
Practice Address - Phone:404-397-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor