Provider Demographics
NPI:1033476932
Name:DR. KENNETH R WEIL, P.C.
Entity Type:Organization
Organization Name:DR. KENNETH R WEIL, P.C.
Other - Org Name:CHIROPRACTIC WORKS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-350-8000
Mailing Address - Street 1:1715 HOWELL MILL RD NW STE C12
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3117
Mailing Address - Country:US
Mailing Address - Phone:404-350-8000
Mailing Address - Fax:
Practice Address - Street 1:1715 HOWELL MILL RD NW STE C12
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3117
Practice Address - Country:US
Practice Address - Phone:404-350-8000
Practice Address - Fax:404-350-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDQPMedicare PIN