Provider Demographics
NPI:1083792238
Name:DEBEASE, ROBERT GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:DEBEASE
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 1:90 GLENDA TRCE STE I
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3868
Mailing Address - Country:US
Mailing Address - Phone:770-304-1500
Mailing Address - Fax:770-304-8148
Practice Address - Street 1:90 GLENDA TRCE STE I
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3868
Practice Address - Country:US
Practice Address - Phone:770-304-1500
Practice Address - Fax:770-304-8148
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDWZMedicare PIN