MEDICARE: CUMMING CHIROPRACTIC CENTER, P.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	001930	GA

General Provider Information

NPI Number	:	1598842106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMMING CHIROPRACTIC CENTER, P.C.

Provider Business Mailing Address
First Line	:	299 CANTON RD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2303
Country	:	US
Telephone Number	:	770-889-2208
Fax Number	:	770-889-0277

Provider Business Practice Location Address
First Line	:	100 N MAIN ST
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2422
Country	:	US
Telephone Number	:	770-889-2208
Fax Number	:	770-889-0277

Authorized Official
Title or Position	:	OFC MANAGER
Name	:	MRS. KIM B GREGORY
Credential	:
Telephone Number	:	770-889-2208

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/22/2010

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