Provider Demographics
NPI:1285656637
Name:HOROWITZ, KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:HOROWITZ
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 1:830 PLEASANT HILL RD NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2742
Mailing Address - Country:US
Mailing Address - Phone:770-925-9955
Mailing Address - Fax:770-923-0200
Practice Address - Street 1:830 PLEASANT HILL RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2742
Practice Address - Country:US
Practice Address - Phone:770-925-9955
Practice Address - Fax:770-923-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2038111N00000X
NJ2444111N00000X
FL4151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA125005Medicare ID - Type Unspecified