Provider Demographics
NPI:1932276151
Name:RANICKI, STEPHEN AAGE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:AAGE
Last Name:RANICKI
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 1:1147 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2115
Mailing Address - Country:US
Mailing Address - Phone:912-748-1506
Mailing Address - Fax:912-748-1507
Practice Address - Street 1:1147 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2115
Practice Address - Country:US
Practice Address - Phone:912-748-1506
Practice Address - Fax:912-748-1507
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor