MEDICARE: NEIGHBORHOOD CHIROPRACTIC & WELLNESS CENTER, 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	6322	GA

General Provider Information

NPI Number	:	1285926006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD CHIROPRACTIC & WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	328 SILVERTHORNE CIR
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-7420
Country	:	US
Telephone Number	:	770-942-3818
Fax Number	:	678-840-9461

Provider Business Practice Location Address
First Line	:	514 W BANKHEAD HWY STE 300
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1737
Country	:	US
Telephone Number	:	770-617-7434
Fax Number	:	678-840-9461

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANIE TAYLOR MAHLE
Credential	:	D.C.
Telephone Number	:	770-942-3818

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/13/2011

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