Provider Demographics
NPI:1053465286
Name:KURT VAUGHN MEININGER
Entity type:Organization
Organization Name:KURT VAUGHN MEININGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:MEININGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-777-0900
Mailing Address - Street 1:5670 ATLANTA HWY
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5903
Mailing Address - Country:US
Mailing Address - Phone:770-777-0900
Mailing Address - Fax:770-777-0990
Practice Address - Street 1:5670 ATLANTA HWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5903
Practice Address - Country:US
Practice Address - Phone:770-777-0900
Practice Address - Fax:770-777-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5015Medicare ID - Type UnspecifiedGROUP NUMBER
GAU69175Medicare UPIN