Provider Demographics
NPI:1245397702
Name:MCRAE, KENNETH L (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:MCRAE
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:2325 LOG CABIN DR SE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6798
Mailing Address - Country:US
Mailing Address - Phone:678-977-3326
Mailing Address - Fax:770-432-1195
Practice Address - Street 1:2325 LOG CABIN DR SE
Practice Address - Street 2:SUITE 107
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6798
Practice Address - Country:US
Practice Address - Phone:770-432-1199
Practice Address - Fax:770-432-1195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA008066332B00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies