MEDICARE: NEW CHIROPRACTIC LLC DBA SPINE CHIROPRACTIC

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

General Provider Information

NPI Number	:	1669348793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CHIROPRACTIC LLC DBA SPINE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2679 BRIDLE RIDGE WAY
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-7676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7380 SPOUT SPRINGS RD STE 140
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-7535
Country	:	US
Telephone Number	:	770-954-7244
Fax Number	:	470-822-1520

Authorized Official
Title or Position	:	MEMBER
Name	:	PRANAV HALVAWALA
Credential	:	DC
Telephone Number	:	770-954-7244

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	01/05/2026

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