MEDICARE: KOLONICK 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	111N00000X	Chiropractor	CHIR007735	GA

General Provider Information

NPI Number	:	1740391358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOLONICK CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	1301 SHILOH RD NW
Second Line	:	SUITE 1310
City	:	KENNESAW
State	:	GA
Zip	:	30144-7147
Country	:	US
Telephone Number	:	770-420-0083
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 SHILOH RD NW
Second Line	:	SUITE 1310
City	:	KENNESAW
State	:	GA
Zip	:	30144-7147
Country	:	US
Telephone Number	:	770-420-0083
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSHUA ALAN KOLONICK
Credential	:	D.C.
Telephone Number	:	770-420-8818

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/27/2008

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