Provider Demographics
NPI:1851498562
Name:DEBARTOLO, FRANK R (DC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:R
Last Name:DEBARTOLO
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:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-1729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:266 SHOE FACTORY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-4628
Practice Address - Country:US
Practice Address - Phone:706-745-1677
Practice Address - Fax:706-745-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2432111N00000X
SC2775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00640758AMedicaid
GA00640758AMedicaid