Provider Demographics
NPI:1467635953
Name:PETER I. LIPNACK
Entity Type:Organization
Organization Name:PETER I. LIPNACK
Other - Org Name:ATHLETIC BIOMECHANIC CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:I
Authorized Official - Last Name:LIPNACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-382-5898
Mailing Address - Street 1:17 S PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3350
Mailing Address - Country:US
Mailing Address - Phone:770-382-5898
Mailing Address - Fax:
Practice Address - Street 1:17 S PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3350
Practice Address - Country:US
Practice Address - Phone:770-382-5898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU35082Medicare UPIN