MEDICARE: DALE JOSEPH LEBDER D.C.

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	CHIR008149	GA

General Provider Information

NPI Number	:	1194903716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE JOSEPH LEBDER D.C.

Provider Business Mailing Address
First Line	:	233 PEACHTREE ST NE
Second Line	:	SUITE 2307
City	:	ATLANTA
State	:	GA
Zip	:	30303-1504
Country	:	US
Telephone Number	:	404-924-7570
Fax Number	:	404-835-4461

Provider Business Practice Location Address
First Line	:	233 PEACHTREE ST NE
Second Line	:	SUITE 2307
City	:	ATLANTA
State	:	GA
Zip	:	30303-1504
Country	:	US
Telephone Number	:	404-924-7570
Fax Number	:	404-835-4461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	03/06/2009

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