MEDICARE: WAKEMAN CHIROPRACTIC AND HEALING CENTER, INC.

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	261Q00000X	Clinic/Center	CHIR005107	GA

General Provider Information

NPI Number	:	1366605198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKEMAN CHIROPRACTIC AND HEALING CENTER, INC.

Provider Business Mailing Address
First Line	:	3001 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3911
Country	:	US
Telephone Number	:	404-248-1771
Fax Number	:	404-248-1826

Provider Business Practice Location Address
First Line	:	3001 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3911
Country	:	US
Telephone Number	:	404-248-1771
Fax Number	:	404-248-1826

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HANS WAKEMAN
Credential	:	DC
Telephone Number	:	404-248-1771

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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