Provider Demographics
NPI:1871954032
Name:KJ HEADLEE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KJ HEADLEE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HEADLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-956-1598
Mailing Address - Street 1:894 CEDAR CREEK CT SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6648
Mailing Address - Country:US
Mailing Address - Phone:678-956-1598
Mailing Address - Fax:
Practice Address - Street 1:20 WHITLOCK PL SW
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3175
Practice Address - Country:US
Practice Address - Phone:678-956-1598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty