Provider Demographics
NPI:1144675653
Name:KULMACZ, PATRICK EDWARD (DC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:EDWARD
Last Name:KULMACZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 PERIMETER LOFTS CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1746
Mailing Address - Country:US
Mailing Address - Phone:614-571-9451
Mailing Address - Fax:
Practice Address - Street 1:9905 N DAVIDSON PKWY STE 107
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4200
Practice Address - Country:US
Practice Address - Phone:770-474-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor