MEDICARE: CHIROPRACTIC HEALTHCARE GROUP LLC

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	CHIR009911	GA
2	111N00000X	Chiropractor	CHIR009897	GA

General Provider Information

NPI Number	:	1134642077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC HEALTHCARE GROUP LLC

Provider Business Mailing Address
First Line	:	2997 COBB PKWY SE UNIT 723182
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31139-2607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 CLEVELAND AVE SW STE 105
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7119
Country	:	US
Telephone Number	:	470-575-0123
Fax Number	:	678-649-2135

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DANIEL RIASE
Credential	:	DC
Telephone Number	:	470-575-0123

Provider Enumeration Date	:	07/23/2017
Last Update Date	:	03/25/2026

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