Provider Demographics
NPI:1942317102
Name:SHERWOOD, KATHLEEN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:SHERWOOD
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 1:1275 MCCONNELL DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3505
Mailing Address - Country:US
Mailing Address - Phone:404-321-0082
Mailing Address - Fax:404-321-2007
Practice Address - Street 1:1275 MCCONNELL DR
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3505
Practice Address - Country:US
Practice Address - Phone:404-321-0082
Practice Address - Fax:404-321-2007
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDZJMedicare UPIN
GA144084Medicare ID - Type Unspecified