Provider Demographics
NPI:1013101617
Name:ABBASTAR, INC
Entity Type:Organization
Organization Name:ABBASTAR, INC
Other - Org Name:ALPINE CHIROPRACTIC/RON RICHARD DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-865-1229
Mailing Address - Street 1:783 S. MAIN ST.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528
Mailing Address - Country:US
Mailing Address - Phone:706-865-1229
Mailing Address - Fax:706-865-1229
Practice Address - Street 1:783 S. MAIN ST.
Practice Address - Street 2:SUITE 10
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528
Practice Address - Country:US
Practice Address - Phone:706-865-1229
Practice Address - Fax:706-865-1229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBASTAR, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-28
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAOOO2765111N00000X
GA002765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGAOOO2765OtherCHIROPRACTIC LISC.
8775677271Medicare UPIN
GAGAOOO2765OtherCHIROPRACTIC LISC.