Provider Demographics
NPI:1255954103
Name:KILLEEN, JAMES JR (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KILLEEN
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 1:3570 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4464
Mailing Address - Country:US
Mailing Address - Phone:678-879-9019
Mailing Address - Fax:678-879-9021
Practice Address - Street 1:3570 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4464
Practice Address - Country:US
Practice Address - Phone:678-879-9019
Practice Address - Fax:678-879-9021
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006650111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician