Provider Demographics
NPI:1588795876
Name:PUSEY, KIRK ALAN (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ALAN
Last Name:PUSEY
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 1:1000 WYNGATE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-592-1877
Mailing Address - Fax:770-592-1876
Practice Address - Street 1:1000 WYNGATE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-592-1877
Practice Address - Fax:770-592-1876
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004770111N00000X
MI2301004794111N00000X
GAPT003266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T33175Medicare UPIN
GA35ZCDBDMedicare PIN