MEDICARE: DR. CHAD ALAN VERMEULEN 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	1310	SD
2	111N00000X	Chiropractor	CH10421	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891236139	OTHER	SD	BLUE CROSS BLUE SHIELD OF GEORGIA, MEDICARE, UNITEDHEALTHCARE, CIGNA

General Provider Information

NPI Number	:	1891236139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD ALAN VERMEULEN D.C.

Provider Business Mailing Address
First Line	:	245 WOODCREST DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2337
Country	:	US
Telephone Number	:	605-770-6894
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 S MILLEDGE AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-1334
Country	:	US
Telephone Number	:	706-546-7700
Fax Number	:

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	09/24/2020

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