MEDICARE: DR. YOUNG AE HAN 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	CHIR006887	GA

General Provider Information

NPI Number	:	1639512940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUNG AE HAN D.C.

Provider Business Mailing Address
First Line	:	1302 BARLASTON CIRCLE
Second Line	:	SUITE 6
City	:	MARIETTA
State	:	GA
Zip	:	30062-8100
Country	:	US
Telephone Number	:	404-392-7592
Fax Number	:	678-547-3814

Provider Business Practice Location Address
First Line	:	3312 PEACHTREE INDUSTRIAL BLVD
Second Line	:	SUITE 6
City	:	DULUTH
State	:	GA
Zip	:	30096-8100
Country	:	US
Telephone Number	:	404-392-7592
Fax Number	:	678-547-3814

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	04/17/2013

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