MEDICARE: JEROME LUBBE 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	111NN0400X	Neurology Chiropractor	13069	TX
2	111NN0400X	Neurology Chiropractor	CHIR009501	GA

General Provider Information

NPI Number	:	1366890915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME LUBBE DC

Provider Business Mailing Address
First Line	:	1950 SPECTRUM CIR SE
Second Line	:	SUITE B-200
City	:	MARIETTA
State	:	GA
Zip	:	30067-8479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 SPECTRUM CIR SE
Second Line	:	SUITE B-200
City	:	MARIETTA
State	:	GA
Zip	:	30067-8479
Country	:	US
Telephone Number	:	404-334-7100
Fax Number	:

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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Directions to “ JEROME LUBBE DC” Practice Location

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