Provider Demographics
NPI:1609990563
Name:HABERSKI, LARRY K (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:K
Last Name:HABERSKI
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 1:4203 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1206
Mailing Address - Country:US
Mailing Address - Phone:404-294-5050
Mailing Address - Fax:404-292-5348
Practice Address - Street 1:4203 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1206
Practice Address - Country:US
Practice Address - Phone:404-294-5050
Practice Address - Fax:404-292-5348
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1969111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97617Medicare UPIN