MEDICARE: NEW LIFE CHIROPRACTIC 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

General Provider Information

NPI Number	:	1649444571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	3451 COBB PKWY NW STE 4
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-4000
Country	:	US
Telephone Number	:	678-574-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 COBB PKWY NW STE 4
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-4000
Country	:	US
Telephone Number	:	678-574-5678
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. AMY VALENTE
Credential	:
Telephone Number	:	678-574-5678

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	03/14/2013

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