Provider Demographics
NPI:1174823546
Name:KENNEY, JUSTIN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:KENNEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 WEATHERSTONE DR
Mailing Address - Street 2:SUITE 940
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7005
Mailing Address - Country:US
Mailing Address - Phone:678-388-7670
Mailing Address - Fax:678-388-7671
Practice Address - Street 1:99 WEATHERSTONE DR
Practice Address - Street 2:SUITE 940
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7005
Practice Address - Country:US
Practice Address - Phone:678-388-7670
Practice Address - Fax:678-388-7671
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor