MEDICARE: KATHLEEN MARIE SHERWOOD DC

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	05269	GA

General Provider Information

NPI Number	:	1942317102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARIE SHERWOOD DC

Provider Business Mailing Address
First Line	:	1275 MCCONNELL DR
Second Line	:	SUITE E
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:	404-321-0082
Fax Number	:	404-321-2007

Provider Business Practice Location Address
First Line	:	1275 MCCONNELL DR
Second Line	:	SUITE E
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:	404-321-0082
Fax Number	:	404-321-2007

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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