MEDICARE: GRAVANTE CHIROPRACTIC & NUTRITION INC.

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	CHIR002063	GA

General Provider Information

NPI Number	:	1841536000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAVANTE CHIROPRACTIC & NUTRITION INC.

Provider Business Mailing Address
First Line	:	2795 MAIN STREET
Second Line	:	STE B, BLDG 14
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2374
Country	:	US
Telephone Number	:	678-990-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2795 MAIN STREET
Second Line	:	STE B, BLDG 14
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2374
Country	:	US
Telephone Number	:	678-990-9400
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTER
Name	:	MRS. LORRAINE SCOTT GRAVANTE
Credential	:	D.C.
Telephone Number	:	678-990-9400

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	06/15/2023

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