MEDICARE: ATLANTA CHIROPRACTIC AND REHAB 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	:	1366182438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA CHIROPRACTIC AND REHAB LLC

Provider Business Mailing Address
First Line	:	2053 STANTON RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-1311
Country	:	US
Telephone Number	:	404-698-3682
Fax Number	:	833-623-4907

Provider Business Practice Location Address
First Line	:	2053 STANTON RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-1311
Country	:	US
Telephone Number	:	404-698-3682
Fax Number	:	833-623-4907

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ASHLEY WOOTEN
Credential	:	DC
Telephone Number	:	912-224-1731

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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