=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720103146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORSESHOE BEND CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 POWDER SPRINGS RD SW STE 230
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30064-4848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-429-1400
-----------------------------------------------------
Fax | 770-426-8828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1750 POWDER SPRINGS RD SW STE 230
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30064-4848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-429-1400
-----------------------------------------------------
Fax | 770-426-8828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN WARREN RABSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 770-429-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR005363
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------