Provider Demographics
NPI:1912067893
Name:KALB, CHARLES WILLIAM JR (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:KALB
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:3681 SUMMIT DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4077
Mailing Address - Country:US
Mailing Address - Phone:770-387-1144
Mailing Address - Fax:770-382-4777
Practice Address - Street 1:931 N TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2442
Practice Address - Country:US
Practice Address - Phone:770-387-1144
Practice Address - Fax:770-382-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR001009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582003732Medicare UPIN
GA35ZCCJKMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER