MEDICARE: MR. LOUIS M. OKUN D.C.

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	CHIR002848	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58-2155004	OTHER	GA	TAX ID

General Provider Information

NPI Number	:	1477669752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOUIS M. OKUN D.C.

Provider Business Mailing Address
First Line	:	6703 SHANNON PKWY
Second Line	:	SUITE # 13-14
City	:	UNION CITY
State	:	GA
Zip	:	30291-2073
Country	:	US
Telephone Number	:	770-964-3334
Fax Number	:	770-306-2680

Provider Business Practice Location Address
First Line	:	6703 SHANNON PKWY
Second Line	:	SUITE # 13-14
City	:	UNION CITY
State	:	GA
Zip	:	30291-2073
Country	:	US
Telephone Number	:	770-964-3334
Fax Number	:	770-306-2680

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/25/2016

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Directions to “ MR. LOUIS M. OKUN D.C.” Practice Location

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