Healthcare Provider Details

I. General information

NPI: 1164846481
Provider Name (Legal Business Name): CHARLES WILLIAM CILINSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SHILOH RD NW STE 1610
KENNESAW GA
30144-7168
US

IV. Provider business mailing address

1301 SHILOH RD NW STE 1610
KENNESAW GA
30144-7168
US

V. Phone/Fax

Practice location:
  • Phone: 770-218-1166
  • Fax: 770-218-1006
Mailing address:
  • Phone: 770-218-1166
  • Fax: 770-218-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009246
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: