MEDICARE: DR. JEREMY MICHAEL SEDLOCK 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	CHIR008982	GA

General Provider Information

NPI Number	:	1609137827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY MICHAEL SEDLOCK D.C.

Provider Business Mailing Address
First Line	:	3338 PEACHTREE RD NE APT 608
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1463
Country	:	US
Telephone Number	:	678-787-6941
Fax Number	:

Provider Business Practice Location Address
First Line	:	9700 MEDLOCK BRIDGE RD
Second Line	:	STE 132
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-4409
Country	:	US
Telephone Number	:	770-450-9394
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	10/26/2017

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