Provider Demographics
NPI:1912116914
Name:KEN ZOODSMA & ASSOCIATES
Entity Type:Organization
Organization Name:KEN ZOODSMA & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ZOODSMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-390-6321
Mailing Address - Street 1:12485 CONCORD HALL DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4386
Mailing Address - Country:US
Mailing Address - Phone:478-390-6321
Mailing Address - Fax:
Practice Address - Street 1:749 RIVERSIDE DRIVE LN
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2658
Practice Address - Country:US
Practice Address - Phone:478-390-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty