=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457508517
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES RACHAUN ALBERTY B.S, D.C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2008
-----------------------------------------------------
Last Update Date | 08/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1374 E 36TH ST SUITE 2801 B
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44114-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-400-7474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3714 WOODLAKE RD
-----------------------------------------------------
City | HEPHZIBAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30815-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-714-2626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008368
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 4036
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------