Provider Demographics
NPI:1154757490
Name:TOWNSEND, KEVIN W (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:TOWNSEND
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 1:2425 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3415
Mailing Address - Country:US
Mailing Address - Phone:706-543-2584
Mailing Address - Fax:706-354-0702
Practice Address - Street 1:21 W ROBERT TOOMBS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1661
Practice Address - Country:US
Practice Address - Phone:706-678-3292
Practice Address - Fax:706-678-3147
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor