MEDICARE: DR. JOHN ANDREW RADIN 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	CHIR005936	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52671994	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730204447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANDREW RADIN D.C.

Provider Business Mailing Address
First Line	:	2122 YORKSHIRE CT
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 CANTON RD STE 520
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5395
Country	:	US
Telephone Number	:	770-795-0506
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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