MEDICARE: CHESTNUT MOUNTAIN CHIROPRACTIC

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	111NI0013X	Independent Medical Examiner Chiropractor	6952	GA

General Provider Information

NPI Number	:	1124204607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTNUT MOUNTAIN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3703 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3015
Country	:	US
Telephone Number	:	770-532-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3015
Country	:	US
Telephone Number	:	770-532-2220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH MICHAEL HOCK
Credential	:	D.C
Telephone Number	:	770-532-2220

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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