MEDICARE: EAGLES LANDING WELLNESS AND CHIROPRACTIC CENTER INC

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	CHIR006719	GA

General Provider Information

NPI Number	:	1659591972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLES LANDING WELLNESS AND CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	69 OLD JACKSON RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-3095
Country	:	US
Telephone Number	:	678-432-3303
Fax Number	:	678-432-3307

Provider Business Practice Location Address
First Line	:	69 OLD JACKSON RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-3095
Country	:	US
Telephone Number	:	678-432-3303
Fax Number	:	678-432-3307

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANIE RYTEL-SMITH
Credential	:	D.C.
Telephone Number	:	678-432-3303

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	09/06/2012

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