MEDICARE: DR. PETER R. CRANTON 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	CHIROO6268	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CHIROO6268	OTHER	GA	STATE LICENSE
2	01-0696764	OTHER	GA	TAX ID #

General Provider Information

NPI Number	:	1528180627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER R. CRANTON D.C.

Provider Business Mailing Address
First Line	:	2300 PEACHTREE RD NE
Second Line	:	B204
City	:	ATLANTA
State	:	GA
Zip	:	30309-1142
Country	:	US
Telephone Number	:	404-355-3455
Fax Number	:	404-355-3665

Provider Business Practice Location Address
First Line	:	2300 PEACHTREE RD NE
Second Line	:	B204
City	:	ATLANTA
State	:	GA
Zip	:	30309-1142
Country	:	US
Telephone Number	:	404-355-3455
Fax Number	:	404-355-3665

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	02/04/2010

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