Provider Demographics
NPI:1073686366
Name:KIMURA, KORTNEY (DC)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:KIMURA
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 1:218 JULIA LYNN LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-8184
Mailing Address - Country:US
Mailing Address - Phone:678-656-7373
Mailing Address - Fax:
Practice Address - Street 1:3745 CHEROKEE ST NW STE 606
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6785
Practice Address - Country:US
Practice Address - Phone:678-656-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor