Provider Demographics
NPI:1386794535
Name:KEIBLER-GATIEN, KIMBERLY DAWN (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:KEIBLER-GATIEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 GLADE RD SE LOT 9
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-6856
Mailing Address - Country:US
Mailing Address - Phone:678-755-8488
Mailing Address - Fax:
Practice Address - Street 1:80 LACY STREET SW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1112
Practice Address - Country:US
Practice Address - Phone:770-429-0507
Practice Address - Fax:770-429-0954
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFGRMedicare ID - Type Unspecified