Provider Demographics
NPI:1053664805
Name:RADIN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:RADIN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-926-1669
Mailing Address - Street 1:2300 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2075
Mailing Address - Country:US
Mailing Address - Phone:770-926-1669
Mailing Address - Fax:770-926-2155
Practice Address - Street 1:2300 SHALLOWFORD RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2075
Practice Address - Country:US
Practice Address - Phone:770-926-1669
Practice Address - Fax:770-926-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1033285440OtherTYPE 1 NPI / NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM