Provider Demographics
NPI:1407118458
Name:SMITH, KEVIN CHARLES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2680 COBB PKWY NW STE C
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3470
Mailing Address - Country:US
Mailing Address - Phone:770-629-9885
Mailing Address - Fax:770-430-8750
Practice Address - Street 1:2680 COBB PKWY NW STE C
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3470
Practice Address - Country:US
Practice Address - Phone:770-629-9885
Practice Address - Fax:770-430-8750
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor