Healthcare Provider Details

I. General information

NPI: 1144435926
Provider Name (Legal Business Name): MICHAEL G. ALPINE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRIAN DAVID BLAKE M.D.

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 GLENRIDGE DR. SUITE 232
ATLANTA GA
30342
US

IV. Provider business mailing address

5450 GLENRIDGE DR. SUITE 232
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 678-644-3782
  • Fax:
Mailing address:
  • Phone: 678-644-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR005865
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberD40613
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: