Provider Demographics
NPI:1952660631
Name:MCQUEEN, KENDRICK D (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:D
Last Name:MCQUEEN
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 1:4502 CREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5793
Mailing Address - Country:US
Mailing Address - Phone:404-939-1236
Mailing Address - Fax:
Practice Address - Street 1:4292 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1224
Practice Address - Country:US
Practice Address - Phone:404-548-5154
Practice Address - Fax:404-393-3450
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008905111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation