MEDICARE: MASON MILL CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1295445187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASON MILL CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1275 MCCONNELL DR STE E
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:	404-321-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 MCCONNELL DR STE E
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:	404-321-0082
Fax Number	:	404-321-2007

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. RICHARD COHEN
Credential	:	D.C.
Telephone Number	:	321-544-9645

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/01/2022

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