Provider Demographics
NPI:1790968584
Name:MICHAEL S RAPPAPORT PC
Entity Type:Organization
Organization Name:MICHAEL S RAPPAPORT PC
Other - Org Name:A FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-427-0044
Mailing Address - Street 1:590 COBB PKWY S
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6517
Mailing Address - Country:US
Mailing Address - Phone:770-427-0044
Mailing Address - Fax:770-428-9695
Practice Address - Street 1:590 COBB PKWY S
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6517
Practice Address - Country:US
Practice Address - Phone:770-427-0044
Practice Address - Fax:770-428-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROPRACTOR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR001559OtherSTATE LICENSE
GAGRP6939OtherMEDICARE GROUP #
GAT97798Medicare UPIN