Healthcare Provider Details

I. General information

NPI: 1427261957
Provider Name (Legal Business Name): KIMBERLY ANNE VACCARO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 OLD HWY 5 SUITE 1
WOODSTOCK GA
30188
US

IV. Provider business mailing address

PO BOX 2031
ACWORTH GA
30102
US

V. Phone/Fax

Practice location:
  • Phone: 678-494-6735
  • Fax: 678-494-6737
Mailing address:
  • Phone: 678-494-6735
  • Fax: 678-494-6737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: