Provider Demographics
NPI:1902988165
Name:KAWAMOTO, KELLEY (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:KAWAMOTO
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0020
Mailing Address - Country:US
Mailing Address - Phone:404-547-4987
Mailing Address - Fax:
Practice Address - Street 1:4153 RIVER MILL DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2125
Practice Address - Country:US
Practice Address - Phone:404-547-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO7030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor