MEDICARE: STARBRIDGE CHIROPRACTIC, 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	CHIR001496	GA

General Provider Information

NPI Number	:	1942545280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARBRIDGE CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	326 STARBRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-2817
Country	:	US
Telephone Number	:	706-864-0882
Fax Number	:	706-867-7969

Provider Business Practice Location Address
First Line	:	326 STARBRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-2817
Country	:	US
Telephone Number	:	706-864-0882
Fax Number	:	706-867-7969

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONNA A SULLIVAN
Credential	:	D.C.
Telephone Number	:	706-864-0882

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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