Provider Demographics
NPI:1033288048
Name:FLYTHE, KEVIN D (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:FLYTHE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8602
Mailing Address - Country:US
Mailing Address - Phone:770-988-0988
Mailing Address - Fax:770-988-8989
Practice Address - Street 1:2330 WINDY HILL RD SE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8602
Practice Address - Country:US
Practice Address - Phone:770-988-0988
Practice Address - Fax:770-988-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35CZHMDMedicare UPIN