MEDICARE: COMPREHENSIVE WELLNESS CENTERS, 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	CHIR005239	GA

General Provider Information

NPI Number	:	1609315803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE WELLNESS CENTERS, LLC

Provider Business Mailing Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:	770-439-0297

Provider Business Practice Location Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:	770-439-0297

Authorized Official
Title or Position	:	CEO/DIRECTOR
Name	:	BARBARA A KAISER
Credential	:	D,C,
Telephone Number	:	770-565-2882

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	02/21/2017

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