MEDICARE: DR. CRAIG K. PETEK 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	111N00000X	Chiropractor	1292	GA

General Provider Information

NPI Number	:	1497754535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG K. PETEK DC

Provider Business Mailing Address
First Line	:	6470 SPALDING DR
Second Line	:	STE. J
City	:	NORCROSS
State	:	GA
Zip	:	30092-1807
Country	:	US
Telephone Number	:	770-447-5116
Fax Number	:	770-447-0900

Provider Business Practice Location Address
First Line	:	6470 SPALDING DR
Second Line	:	STE. J
City	:	NORCROSS
State	:	GA
Zip	:	30092-1807
Country	:	US
Telephone Number	:	770-447-5116
Fax Number	:	770-447-0900

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/09/2010

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