Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 006650 | GA |
NPI | 1255954103 |
---|---|
Provider Name | James Killeen JR. |
First Address | Alpharetta, GA 30005-4464 |
Second Address | Alpharetta, GA 30005-4464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2020 |
Last Update Date | 27/05/2020 |