Provider Demographics
NPI:1083770846
Name:RINCON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RINCON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SCHNOBRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-826-4490
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:5779 HWY 21S
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-0752
Mailing Address - Country:US
Mailing Address - Phone:912-826-4490
Mailing Address - Fax:912-826-2844
Practice Address - Street 1:5779 HWY 21 S
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5554
Practice Address - Country:US
Practice Address - Phone:912-826-4490
Practice Address - Fax:912-826-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00807067AMedicaid
GA00807067AMedicaid
GAU66806Medicare UPIN
GA511G350008Medicare PIN