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General NPI Number Information
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NPI Number | 1306996665
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Entity Type | Organization
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Legal Business Name | JTK INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 3070 WINDWARD PLZ STE K-1
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City | ALPHARETTA
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State | GA
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Zip | 30005
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Country | US
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Telephone | 678-879-9019
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Fax | 678-879-9021
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Provider Business Mailing Address
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Address Line | 3070 WINDWARD PLZ STE K-1
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City | ALPHARETTA
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State | GA
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Zip | 30005
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Country | US
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Telephone | 678-879-9019
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Fax | 678-879-9021
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Authorized Official
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Title or Position | MANAGER/PRESIDENT
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Name | MR. JAMES THOMAS KILLEEN JR.
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Credential |
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Telephone | 678-879-9019
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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 | CH8912
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR006650
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License Number State | GA
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