MEDICARE: DAVID L. OLT 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	5356	GA
2	111N00000X	Chiropractor	1869	SC

General Provider Information

NPI Number	:	1043326598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L. OLT D.C.

Provider Business Mailing Address
First Line	:	2964 PEACHTREE RD NW
Second Line	:	SUITE 105
City	:	ATLANTA
State	:	GA
Zip	:	30305-2153
Country	:	US
Telephone Number	:	404-231-8770
Fax Number	:	404-231-8760

Provider Business Practice Location Address
First Line	:	2964 PEACHTREE RD NW
Second Line	:	SUITE 105
City	:	ATLANTA
State	:	GA
Zip	:	30305-2153
Country	:	US
Telephone Number	:	404-231-8770
Fax Number	:	404-231-8760

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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