Healthcare Provider Details

I. General information

NPI: 1922006774
Provider Name (Legal Business Name): RICHARD C ROSENKOETTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5064 ROSWELL RD NE SUITE C-201
ATLANTA GA
30342-2281
US

IV. Provider business mailing address

5064 ROSWELL RD NE SUITE C-201
ATLANTA GA
30342-2281
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-2440
  • Fax: 404-233-2441
Mailing address:
  • Phone: 404-233-2440
  • Fax: 404-233-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR001650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: