Provider Demographics
NPI:1093834616
Name:WEINER, KENNETH STEPHEN (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:STEPHEN
Last Name:WEINER
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 1:1642 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3621
Mailing Address - Country:US
Mailing Address - Phone:770-973-8800
Mailing Address - Fax:770-971-6962
Practice Address - Street 1:1642 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3621
Practice Address - Country:US
Practice Address - Phone:770-973-8800
Practice Address - Fax:770-971-6962
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1048111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation