Provider Demographics
NPI:1740460336
Name:PHILEMON ENTERPRISES LLC
Entity type:Organization
Organization Name:PHILEMON ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-493-9765
Mailing Address - Street 1:111 NACOOCHEE WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9020
Mailing Address - Country:US
Mailing Address - Phone:678-493-9765
Mailing Address - Fax:
Practice Address - Street 1:105 MIRRAMONT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8214
Practice Address - Country:US
Practice Address - Phone:678-445-7055
Practice Address - Fax:678-445-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty