MEDICARE: SPINEALIGN CENTERS OF ATLANTA

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	CHIR008915	GA

General Provider Information

NPI Number	:	1396132783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINEALIGN CENTERS OF ATLANTA

Provider Business Mailing Address
First Line	:	1195 FAIRBURN RD SW
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30331-2150
Country	:	US
Telephone Number	:	678-974-5462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1195 FAIRBURN RD SW
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30331-2150
Country	:	US
Telephone Number	:	678-974-5462
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHERRA CONDE
Credential	:	DC
Telephone Number	:	678-974-5462

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	04/23/2015

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Directions to “SPINEALIGN CENTERS OF ATLANTA ” Practice Location

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