Provider Demographics
NPI:1477209716
Name:100 CHIRO KOUNTZ
Entity Type:Organization
Organization Name:100 CHIRO KOUNTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-651-4574
Mailing Address - Street 1:506 PENTWORTH CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7130
Mailing Address - Country:US
Mailing Address - Phone:678-651-4574
Mailing Address - Fax:
Practice Address - Street 1:3999 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1100
Practice Address - Country:US
Practice Address - Phone:678-651-4574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty