Provider Demographics
NPI:1104973601
Name:REIMAN, KEVIN LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LYNN
Last Name:REIMAN
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 1:1330 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6406
Mailing Address - Country:US
Mailing Address - Phone:770-887-7234
Mailing Address - Fax:770-887-7239
Practice Address - Street 1:1330 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6406
Practice Address - Country:US
Practice Address - Phone:770-887-7234
Practice Address - Fax:770-887-7239
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001593111N00000X
GACHIRO09238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA193941OtherBLUE CROSS BLUE SHIELD
VA193941OtherBLUE CROSS BLUE SHIELD
VAC08121Medicare UPIN