MEDICARE: KONDYLES CHIROPRACTIC PC

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	CHIR007849	GA

General Provider Information

NPI Number	:	1124272711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONDYLES CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1607B MARTHA BERRY BLVD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1621
Country	:	US
Telephone Number	:	706-235-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607B MARTHA BERRY BLVD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1621
Country	:	US
Telephone Number	:	706-235-6467
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW KONDYLES
Credential	:	DC
Telephone Number	:	706-235-6467

Provider Enumeration Date	:	11/09/2008
Last Update Date	:	11/09/2008

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