MEDICARE: EASE WELLNESS CHIROPRACTIC

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	302R00000X	Health Maintenance Organization	CHIR009485	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202I357904	OTHER	GA	MEDICARE PTAN

General Provider Information

NPI Number	:	1366895740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASE WELLNESS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	659 AUBURN AVE NE
Second Line	:	STE G4
City	:	ATLANTA
State	:	GA
Zip	:	30312-5412
Country	:	US
Telephone Number	:	404-566-5247
Fax Number	:

Provider Business Practice Location Address
First Line	:	659 AUBURN AVE NE
Second Line	:	STE G4
City	:	ATLANTA
State	:	GA
Zip	:	30312-5412
Country	:	US
Telephone Number	:	404-566-5247
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MAYUR CARA
Credential	:	DC
Telephone Number	:	404-566-5247

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	03/30/2017

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