Provider Demographics
NPI:1720103146
Name:HORSESHOE BEND CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:HORSESHOE BEND CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:RABSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-429-1400
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW STE 230
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4848
Mailing Address - Country:US
Mailing Address - Phone:770-429-1400
Mailing Address - Fax:770-426-8828
Practice Address - Street 1:1750 POWDER SPRINGS RD SW STE 230
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4848
Practice Address - Country:US
Practice Address - Phone:770-429-1400
Practice Address - Fax:770-426-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU60399Medicare UPIN
GA35ZCHGNMedicare ID - Type Unspecified