MEDICARE: DR. BENEDICT V CAVALIERE JR. CHIROPRACTOR

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	CHIR008734	GA
2	111NR0400X	Rehabilitation Chiropractor	CHIR008734	GA

General Provider Information

NPI Number	:	1366743171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENEDICT V CAVALIERE JR. CHIROPRACTOR

Provider Business Mailing Address
First Line	:	2050 CUMMING HWY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114-8614
Country	:	US
Telephone Number	:	770-345-9600
Fax Number	:	770-345-9611

Provider Business Practice Location Address
First Line	:	2050 CUMMING HWY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114-8614
Country	:	US
Telephone Number	:	770-345-9600
Fax Number	:	770-345-9611

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

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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