MEDICARE: ERIC GLEN CHELEKIS 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	CHIR006026	GA

General Provider Information

NPI Number	:	1235158478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC GLEN CHELEKIS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30237-0069
Country	:	US
Telephone Number	:	770-961-5577
Fax Number	:	770-961-1407

Provider Business Practice Location Address
First Line	:	1630 PLEASANT HILL RD
Second Line	:	SUITE 230
City	:	DULUTH
State	:	GA
Zip	:	30096-5899
Country	:	US
Telephone Number	:	770-923-9050
Fax Number	:	770-279-8379

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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