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General NPI Number Information
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NPI Number | 1104236777
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Entity Type | Organization
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Legal Business Name | NAM KI CHIROPRACTIC L.L.C
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 3230 STEVE REYNOLDS BLVD STE 208
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City | DULUTH
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State | GA
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Zip | 30096
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Country | US
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Telephone | 770-418-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 STEVE REYNOLDS BLVD STE 208
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City | DULUTH
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State | GA
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Zip | 30096-8832
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Country | US
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Telephone | 770-418-1110
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Fax |
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Authorized Official
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Title or Position | DR.NAM
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Name | KIKWANG NAM
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Credential |
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Telephone | 770-418-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR008082
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License Number State | GA
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