Provider Demographics
NPI:1609697713
Name:THOMAS, KIRSTEN (DC)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COBB PKWY SE APT 2312
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7750
Mailing Address - Country:US
Mailing Address - Phone:770-815-0320
Mailing Address - Fax:
Practice Address - Street 1:1605 CHURCH ST STE 665
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6074
Practice Address - Country:US
Practice Address - Phone:404-343-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor