MEDICARE: HEALTHCHOICE CLINIC OF JOHNS CREEK.L.L.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	CHIRO 5305	GA

General Provider Information

NPI Number	:	1700035037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCHOICE CLINIC OF JOHNS CREEK.L.L.C.

Provider Business Mailing Address
First Line	:	766 FAIRFIELD DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4104
Country	:	US
Telephone Number	:	404-402-1903
Fax Number	:	678-909-0659

Provider Business Practice Location Address
First Line	:	4535 WINTERS CHAPEL RD
Second Line	:	SUITE B
City	:	DORAVILLE
State	:	GA
Zip	:	30360-2705
Country	:	US
Telephone Number	:	678-957-0266
Fax Number	:	678-909-0659

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	DR. MATTHEW MICHAEL DIDURO
Credential	:	B.S., D.C.
Telephone Number	:	404-402-1903

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	10/22/2014

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