Healthcare Provider Details

I. General information

NPI: 1851426563
Provider Name (Legal Business Name): KEVIN CROWDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MARTIN LUTHER KING JR DR SW SUITE J-4
ATLANTA GA
30311-1500
US

IV. Provider business mailing address

2080 BEECHER RD SW
ATLANTA GA
30311-2651
US

V. Phone/Fax

Practice location:
  • Phone: 404-691-8881
  • Fax: 404-691-8999
Mailing address:
  • Phone: 404-753-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR006257
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: