Provider Demographics
NPI:1699984088
Name:KENNSTAR LLC
Entity type:Organization
Organization Name:KENNSTAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABNER
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-428-4416
Mailing Address - Street 1:630 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1172
Mailing Address - Country:US
Mailing Address - Phone:770-428-4416
Mailing Address - Fax:770-428-2693
Practice Address - Street 1:630 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1172
Practice Address - Country:US
Practice Address - Phone:770-428-4416
Practice Address - Fax:770-428-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO02616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty