Provider Demographics
NPI:1003007071
Name:MCKENNA, JOSEPH WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:923 DILL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-4145
Mailing Address - Country:US
Mailing Address - Phone:404-753-3141
Mailing Address - Fax:404-756-1070
Practice Address - Street 1:923 DILL AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-4145
Practice Address - Country:US
Practice Address - Phone:404-753-3141
Practice Address - Fax:404-756-1070
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor