MEDICARE: ON SITE HEALTH CARE SERVICES LLC

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	CHIR005518	GA

General Provider Information

NPI Number	:	1073873840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON SITE HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1100 OLD DAWSON VILLAGE RD E STE 10
Second Line	:
City	:	DAWSONVILLE
State	:	GA
Zip	:	30534-3807
Country	:	US
Telephone Number	:	770-894-4951
Fax Number	:	770-992-3676

Provider Business Practice Location Address
First Line	:	1100 OLD DAWSON VILLAGE RD E STE 10
Second Line	:
City	:	DAWSONVILLE
State	:	GA
Zip	:	30534-3807
Country	:	US
Telephone Number	:	770-894-4951
Fax Number	:	770-992-3676

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK DEBRINCAT
Credential	:	DC
Telephone Number	:	770-894-4951

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	05/25/2012

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