MEDICARE: DR. KEVIN SCOTT KAZAKEVICH 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	111NR0400X	Rehabilitation Chiropractor	CHIR009027	GA

General Provider Information

NPI Number	:	1912253048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN SCOTT KAZAKEVICH D.C.

Provider Business Mailing Address
First Line	:	327 CABARET CT SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3617
Country	:	US
Telephone Number	:	404-944-6548
Fax Number	:

Provider Business Practice Location Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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