Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1048 | GA |
NPI | 1093834616 |
---|---|
Provider Name | Kenneth Stephen Weiner |
First Address | Marietta, GA 30062-3621 |
Second Address | Marietta, GA 30062-3621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |