MEDICARE: DR. ANTHONY DIMOLA DC

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	5520	GA

General Provider Information

NPI Number	:	1295780708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY DIMOLA DC

Provider Business Mailing Address
First Line	:	4515 DENNINGTON TRCE
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7835
Country	:	US
Telephone Number	:	770-924-1995
Fax Number	:	770-924-3930

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/27/2010

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Directions to “ DR. ANTHONY DIMOLA DC” Practice Location

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