MEDICARE: DR. JODI LYN GONTESKI 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	CHIR006238	GA

General Provider Information

NPI Number	:	1538238795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI LYN GONTESKI DC

Provider Business Mailing Address
First Line	:	2164 NORTH RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2668
Country	:	US
Telephone Number	:	678-344-3433
Fax Number	:	678-344-4548

Provider Business Practice Location Address
First Line	:	2164 NORTH RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2668
Country	:	US
Telephone Number	:	678-344-3433
Fax Number	:	678-344-4548

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/24/2011

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