Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR008433 | GA |
N | 111NN1001X | Nutrition | CHIR008433 | GA |
N | 111NP0017X | Pediatric Chiropractor | CHIR008433 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | CHIR008433 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIR008433 | GA |
N | 111NX0100X | Occupational Health | CHIR008433 | GA |
NPI | 1699067728 |
---|---|
Provider Name | Dr. Kimberly Amelia Minick |
First Address | Canton, GA 30114-2708 |
Second Address | Canton, GA 30114-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2011 |
Last Update Date | 08/05/2011 |