MEDICARE: DR. SCOTT STEVEN CARLSON 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	CHIR008095	GA

General Provider Information

NPI Number	:	1326171877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT STEVEN CARLSON D.C.

Provider Business Mailing Address
First Line	:	167 LITTLE VINE LN
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-5620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 ROSWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3716
Country	:	US
Telephone Number	:	404-250-1414
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. SCOTT STEVEN CARLSON D.C.” Practice Location

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