MEDICARE: DR. JENNIFER HAWK WILEY DC

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	CHIR007241	GA

General Provider Information

NPI Number	:	1235140773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER HAWK WILEY DC

Provider Business Mailing Address
First Line	:	PO BOX 813
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-0014
Country	:	US
Telephone Number	:	706-654-2155
Fax Number	:	706-654-2171

Provider Business Practice Location Address
First Line	:	117 BELL AVENUE
Second Line	:
City	:	HOSCHTON
State	:	GA
Zip	:	30548
Country	:	US
Telephone Number	:	706-654-2155
Fax Number	:	706-654-2171

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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