Provider Demographics
NPI:1144435926
Name:ALPINE, MICHAEL G (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:ALPINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:DAVID
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5450 GLENRIDGE DR.
Mailing Address - Street 2:SUITE 232
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:678-644-3782
Mailing Address - Fax:
Practice Address - Street 1:5450 GLENRIDGE DR.
Practice Address - Street 2:SUITE 232
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:678-644-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005865111NR0400X
GAD40613261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFKFMedicare ID - Type Unspecified
GA72610Medicare UPIN