Provider Demographics
NPI:1164682993
Name:KENT, JOHN HERBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERBERT
Last Name:KENT
Suffix:JR
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 1:1505 LAFAYETTE PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-2513
Mailing Address - Country:US
Mailing Address - Phone:706-882-5737
Mailing Address - Fax:
Practice Address - Street 1:1505 LAFAYETTE PKWY
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2513
Practice Address - Country:US
Practice Address - Phone:706-882-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR08331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor