Healthcare Provider Details

I. General information

NPI: 1265579957
Provider Name (Legal Business Name): KENNETH S CALAIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HEAD AVE
TALLAPOOSA GA
30176-1260
US

IV. Provider business mailing address

3624 EDGEWOOD RD STE A
COLUMBUS GA
31907-8238
US

V. Phone/Fax

Practice location:
  • Phone: 770-574-5005
  • Fax: 770-574-5006
Mailing address:
  • Phone: 706-563-3370
  • Fax: 770-695-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2660
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number008148
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: