Provider Demographics
NPI:1730505454
Name:SCHWISOW, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SCHWISOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 ATLANTA RD SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8200
Mailing Address - Country:US
Mailing Address - Phone:678-424-8501
Mailing Address - Fax:678-424-8504
Practice Address - Street 1:3246 ATLANTA RD SE
Practice Address - Street 2:SUITE E
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8200
Practice Address - Country:US
Practice Address - Phone:678-424-8501
Practice Address - Fax:678-424-8504
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor