MEDICARE: DR. KYLE ALEXANDER HANES 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	CHIR009184	GA

General Provider Information

NPI Number	:	1801221361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE ALEXANDER HANES D.C.

Provider Business Mailing Address
First Line	:	116 PONCE DE LEON AVE NE
Second Line	:	#2319
City	:	ATLANTA
State	:	GA
Zip	:	30308-4113
Country	:	US
Telephone Number	:	706-536-4165
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 JUNIPER ST NE
Second Line	:	SUITE 201
City	:	ATLANTA
State	:	GA
Zip	:	30308-1300
Country	:	US
Telephone Number	:	678-439-8581
Fax Number	:

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

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/03/2013

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