Provider Demographics
NPI:1043679418
Name:KCP ENTERPRISES
Entity Type:Organization
Organization Name:KCP ENTERPRISES
Other - Org Name:ELITE REHAB AND WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-5011
Mailing Address - Street 1:1568 SOUTHLAKE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4153
Mailing Address - Country:US
Mailing Address - Phone:470-878-0696
Mailing Address - Fax:
Practice Address - Street 1:1568 SOUTHLAKE PKWY STE C
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260
Practice Address - Country:US
Practice Address - Phone:470-878-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KCP ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006798111N00000X
111NR0400X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty