MEDICARE: SUSAN H STARR DC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1073866125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN H STARR DC, PC

Provider Business Mailing Address
First Line	:	2850 JOHNSON FERRY RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5684
Country	:	US
Telephone Number	:	770-518-8786
Fax Number	:	770-518-9787

Provider Business Practice Location Address
First Line	:	2850 JOHNSON FERRY RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5684
Country	:	US
Telephone Number	:	770-518-8786
Fax Number	:	770-518-9787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSAN STARR
Credential	:
Telephone Number	:	770-518-8786

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	10/25/2012

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