Provider Demographics
NPI:1740407584
Name:KIRK, THOMAS C JR (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:KIRK
Suffix:JR
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 1:820 EBENEZER CHURCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2073
Mailing Address - Country:US
Mailing Address - Phone:770-251-4345
Mailing Address - Fax:770-251-8072
Practice Address - Street 1:820 EBENEZER CHURCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2073
Practice Address - Country:US
Practice Address - Phone:770-251-4345
Practice Address - Fax:770-251-8072
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA663112OtherBCBS
GA35ZCGPRMedicare ID - Type UnspecifiedCOLLEGE PARK LOCATION
GAU74077Medicare UPIN
GA35ZCGPR-01Medicare ID - Type UnspecifiedSHARPSBURG LOCATION