MEDICARE: DR. JOHN ROBERT DULL 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	CHIR001759	GA

General Provider Information

NPI Number	:	1710019021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ROBERT DULL D.C.

Provider Business Mailing Address
First Line	:	4144 CLAIRMONT RD
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-3237
Country	:	US
Telephone Number	:	678-205-1223
Fax Number	:	678-205-1224

Provider Business Practice Location Address
First Line	:	4144 CLAIRMONT RD
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-3237
Country	:	US
Telephone Number	:	678-205-1223
Fax Number	:	678-205-1224

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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