Provider Demographics
NPI:1851490650
Name:MCCORMICK, KELLY A (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:MCCORMICK
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 1:321 DUNESBURY LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4159
Mailing Address - Country:US
Mailing Address - Phone:678-494-6735
Mailing Address - Fax:678-494-6737
Practice Address - Street 1:5101 OLD HIGHWAY 5 STE 1
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:678-494-6735
Practice Address - Fax:678-494-6737
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor