MEDICARE: DR. ALEXIS VICKERS PETRY 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	CHIR011129	GA

General Provider Information

NPI Number	:	1356102115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS VICKERS PETRY DC

Provider Business Mailing Address
First Line	:	920 S MILLEDGE AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-1334
Country	:	US
Telephone Number	:	706-546-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 S MILLEDGE AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-1334
Country	:	US
Telephone Number	:	706-546-7700
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	03/02/2026

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Directions to “ DR. ALEXIS VICKERS PETRY DC” Practice Location

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