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General NPI Number Information
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NPI Number | 1386862480
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Entity Type | Organization
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Legal Business Name | KENNETH O LOGAN, D.C.,P.C.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 2543 BELLS FERRY RD SUITE 500
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City | MARIETTA
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State | GA
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Zip | 30066-5179
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Country | US
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Telephone | 770-428-3671
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Fax | 770-428-2143
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Provider Business Mailing Address
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Address Line | 2543 BELLS FERRY RD SUITE 500
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City | MARIETTA
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State | GA
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Zip | 30066-5179
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Country | US
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Telephone | 770-428-3671
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Fax | 770-428-2143
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH OWEN LOGAN
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Credential | D.C.
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Telephone | 770-428-3671
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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 | 001489
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License Number State | GA
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