MEDICARE: EMANATE WELLNESS CHIROPRACTIC, PC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1700432465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMANATE WELLNESS CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	905 JUNIPER ST NE STE 108
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4129
Country	:	US
Telephone Number	:	404-870-0109
Fax Number	:	404-870-0108

Provider Business Practice Location Address
First Line	:	905 JUNIPER ST NE STE 108
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4129
Country	:	US
Telephone Number	:	404-870-0109
Fax Number	:	404-870-0108

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER ALLAN PETERSON
Credential	:	DC
Telephone Number	:	404-870-0109

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	08/16/2019

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