Healthcare Provider Details

I. General information

NPI: 1114694411
Provider Name (Legal Business Name): JUSTIN KERSTEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 S COBB INDUSTRIAL BLVD SE
SMYRNA GA
30082-4908
US

IV. Provider business mailing address

942 MCLINDEN AVE SE
SMYRNA GA
30080-4142
US

V. Phone/Fax

Practice location:
  • Phone: 404-594-5809
  • Fax:
Mailing address:
  • Phone: 586-744-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR010493
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: