MEDICARE: DR. JOHN HARRELL 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	CHIR009726	GA

General Provider Information

NPI Number	:	1144770678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN HARRELL D.C.

Provider Business Mailing Address
First Line	:	3942 MCGUIRE WAY NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5269
Country	:	US
Telephone Number	:	404-313-2612
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 WYNGATE PKWY STE 200
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-6983
Country	:	US
Telephone Number	:	770-592-1877
Fax Number	:

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

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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