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General NPI Number Information
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NPI Number | 1700671948
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Entity Type | Organization
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Legal Business Name | KOPACETIC KHIROPRACTIC LLC.
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 1003 VIRGINIA AVE STE 200
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City | HAPEVILLE
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State | GA
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Zip | 30354-1387
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Country | US
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Telephone | 404-969-5707
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Fax |
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Provider Business Mailing Address
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Address Line | 6595 ROSWELL RD STE G
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City | ATLANTA
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State | GA
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Zip | 30328-3152
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Country | US
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Telephone | 404-969-5707
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. KEONA FAVIS
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Credential | DC
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Telephone | 318-800-1032
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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 |
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License Number State |
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