Provider Demographics
NPI:1417144981
Name:RENE R. ACOSTA INC.
Entity Type:Organization
Organization Name:RENE R. ACOSTA INC.
Other - Org Name:CHIRO 101
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-252-5077
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:404-252-5077
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:404-252-5077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR00781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty