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General NPI Number Information
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NPI Number | 1841675683
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Entity Type | Individual
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Provider Name | KRISTOPHER JAMES HEADLEE D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 405 PHARR RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-3200
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Country | US
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Telephone | 404-231-1872
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Fax | 404-231-3346
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Provider Business Mailing Address
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Address Line | 894 CEDAR CREEK CT SE
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City | MARIETTA
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State | GA
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Zip | 30067-6648
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Country | US
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Telephone | 406-531-3807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CHIR009542
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License Number State | GA
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