Provider Demographics
NPI:1477628162
Name:BAXTER, KELLIE CHERIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:CHERIE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 HICKORY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2011
Mailing Address - Country:US
Mailing Address - Phone:770-345-1111
Mailing Address - Fax:770-345-1788
Practice Address - Street 1:6875 HICKORY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2011
Practice Address - Country:US
Practice Address - Phone:770-345-1111
Practice Address - Fax:770-345-1788
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007723111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJGQMedicare ID - Type UnspecifiedMEDICARE ID NUMBER