MEDICARE: MICHAEL S ROURA 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	111NS0005X	Sports Physician Chiropractor	CHIR009866	GA

General Provider Information

NPI Number	:	1497296024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S ROURA DC

Provider Business Mailing Address
First Line	:	3565 PIEDMONT RD NE
Second Line	:	BUILDING 2, SUITE 310
City	:	ATLANTA
State	:	GA
Zip	:	30305-8202
Country	:	US
Telephone Number	:	404-352-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3565 PIEDMONT RD NE
Second Line	:	BUILDING 2, SUITE 310
City	:	ATLANTA
State	:	GA
Zip	:	30305-8202
Country	:	US
Telephone Number	:	404-352-8900
Fax Number	:

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

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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