MEDICARE: DR. KRYSTEN BUTLER DUREN 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	CHIRO07779	GA

General Provider Information

NPI Number	:	1326049701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTEN BUTLER DUREN D.C.

Provider Business Mailing Address
First Line	:	53 GREATWOOD DR
Second Line	:
City	:	WHITE
State	:	GA
Zip	:	30184-2892
Country	:	US
Telephone Number	:	770-231-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 COBB PKWY NW
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-4000
Country	:	US
Telephone Number	:	770-974-9220
Fax Number	:	770-974-9221

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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