Provider Demographics
NPI:1851661318
Name:MOBILE JOINTS, LLC
Entity Type:Organization
Organization Name:MOBILE JOINTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-939-0375
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0020
Mailing Address - Country:US
Mailing Address - Phone:404-939-0375
Mailing Address - Fax:187-749-6614
Practice Address - Street 1:4153 RIVER MILL DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2125
Practice Address - Country:US
Practice Address - Phone:404-939-0375
Practice Address - Fax:187-749-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty