MEDICARE: DR. JAMES RAYMOND SOETEBEER D.C., M.S.

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	111NS0005X	Sports Physician Chiropractor	007573	GA

General Provider Information

NPI Number	:	1730375205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RAYMOND SOETEBEER D.C., M.S.

Provider Business Mailing Address
First Line	:	1154 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4263
Country	:	US
Telephone Number	:	770-899-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1154 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4263
Country	:	US
Telephone Number	:	770-899-8830
Fax Number	:

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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