Provider Demographics
NPI:1205985892
Name:KILRAINE, JACQUELINE FRANCES (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:FRANCES
Last Name:KILRAINE
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 1:530 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6308
Mailing Address - Country:US
Mailing Address - Phone:478-953-2611
Mailing Address - Fax:478-953-1481
Practice Address - Street 1:530 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6308
Practice Address - Country:US
Practice Address - Phone:478-953-2611
Practice Address - Fax:478-953-1481
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCHXMedicare ID - Type Unspecified
U41121Medicare UPIN