Provider Demographics
NPI:1912258401
Name:AXT, MICHAEL KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:AXT
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 1:5755 N POINT PKWY
Mailing Address - Street 2:SUITE 72
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1142
Mailing Address - Country:US
Mailing Address - Phone:678-867-7200
Mailing Address - Fax:770-667-7138
Practice Address - Street 1:1700 NORTHSIDE DR NW
Practice Address - Street 2:SUITE A3
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2673
Practice Address - Country:US
Practice Address - Phone:404-351-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor