Healthcare Provider Details

I. General information

NPI: 1578515565
Provider Name (Legal Business Name): RALPH SCHIPSKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 SANDY PLAINS RD
MARIETTA GA
30066-4373
US

IV. Provider business mailing address

2790 SANDY PLAINS RD STE. 201
MARIETTA GA
30066-4373
US

V. Phone/Fax

Practice location:
  • Phone: 770-565-8151
  • Fax: 770-565-8158
Mailing address:
  • Phone: 770-565-8151
  • Fax: 770-565-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: