MEDICARE: DR. MICHAEL KENNETH AXT 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	CHIR008974	GA

General Provider Information

NPI Number	:	1912258401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KENNETH AXT D.C.

Provider Business Mailing Address
First Line	:	5755 N POINT PKWY
Second Line	:	SUITE 72
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-1142
Country	:	US
Telephone Number	:	678-867-7200
Fax Number	:	770-667-7138

Provider Business Practice Location Address
First Line	:	1700 NORTHSIDE DR NW
Second Line	:	SUITE A3
City	:	ATLANTA
State	:	GA
Zip	:	30318-2673
Country	:	US
Telephone Number	:	404-351-1800
Fax Number	:

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

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	05/06/2014

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