Provider Demographics
NPI:1467993766
Name:DUSTIN E ALBANESE LLC
Entity Type:Organization
Organization Name:DUSTIN E ALBANESE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:ALBANESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-740-9200
Mailing Address - Street 1:6495 SHILOH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1635
Mailing Address - Country:US
Mailing Address - Phone:770-740-9200
Mailing Address - Fax:770-752-5607
Practice Address - Street 1:6495 SHILOH RD STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1635
Practice Address - Country:US
Practice Address - Phone:770-740-9200
Practice Address - Fax:770-752-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty