MEDICARE: DR. MARC W. UGELL 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	CHIR005105	GA

General Provider Information

NPI Number	:	1073654356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC W. UGELL D.C.

Provider Business Mailing Address
First Line	:	1995 WINDY HILL RD SE STE 7
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-2273
Country	:	US
Telephone Number	:	770-432-4430
Fax Number	:	770-436-4991

Provider Business Practice Location Address
First Line	:	1995 WINDY HILL RD SE STE 7
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-2273
Country	:	US
Telephone Number	:	770-432-4430
Fax Number	:	770-436-4991

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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