MEDICARE: CONNECT MY BRAIN

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	111NP0017X	Pediatric Chiropractor

General Provider Information

NPI Number	:	1093341737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECT MY BRAIN

Provider Business Mailing Address
First Line	:	4930 LONG ISLAND TER
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2572
Country	:	US
Telephone Number	:	678-787-3744
Fax Number	:

Provider Business Practice Location Address
First Line	:	4930 LONG ISLAND TER
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2572
Country	:	US
Telephone Number	:	678-787-3744
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. LAURA HANSON
Credential	:	DC MS DICCP BCN CAS
Telephone Number	:	678-501-5172

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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