Provider Demographics
NPI:1821423542
Name:KYLEHANESPC
Entity Type:Organization
Organization Name:KYLEHANESPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-439-8581
Mailing Address - Street 1:814 JUNIPER ST NE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1300
Mailing Address - Country:US
Mailing Address - Phone:678-439-8581
Mailing Address - Fax:
Practice Address - Street 1:814 JUNIPER ST NE
Practice Address - Street 2:SUITE #201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1300
Practice Address - Country:US
Practice Address - Phone:678-439-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty