Provider Demographics
NPI:1245391929
Name:KITCHENS, MARCELLUS B (DC)
Entity Type:Individual
Prefix:
First Name:MARCELLUS
Middle Name:B
Last Name:KITCHENS
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 1:2314 WINGFOOT PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2810
Mailing Address - Country:US
Mailing Address - Phone:404-288-6289
Mailing Address - Fax:404-288-6289
Practice Address - Street 1:2293 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6403
Practice Address - Country:US
Practice Address - Phone:770-981-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1938OtherGA LICENSE #