Provider Demographics
NPI:1669507067
Name:KAUFFMAN, KEITH LEONARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LEONARD
Last Name:KAUFFMAN
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 1:1512 PIEDMONT AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5024
Mailing Address - Country:US
Mailing Address - Phone:404-872-4476
Mailing Address - Fax:404-872-0204
Practice Address - Street 1:1512 PIEDMONT AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5024
Practice Address - Country:US
Practice Address - Phone:404-872-4476
Practice Address - Fax:404-872-0204
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBXXMedicare ID - Type Unspecified