MEDICARE: DR. MITCHELL R GANA 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	CHIR007683	GA

General Provider Information

NPI Number	:	1285626432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL R GANA D.C.

Provider Business Mailing Address
First Line	:	264 LANCASTER CIR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5912
Country	:	US
Telephone Number	:	770-792-3383
Fax Number	:	770-792-2425

Provider Business Practice Location Address
First Line	:	1301 SHILOH RD NW
Second Line	:	SUITE 1440
City	:	KENNESAW
State	:	GA
Zip	:	30144-7147
Country	:	US
Telephone Number	:	770-792-3383
Fax Number	:	770-792-2425

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/14/2008

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