Provider Demographics
NPI:1295268639
Name:KAIZEN HEALTHCARE
Entity type:Organization
Organization Name:KAIZEN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIERDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-688-9397
Mailing Address - Street 1:855 MOUNT VERNON HWY NE
Mailing Address - Street 2:#100
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4249
Mailing Address - Country:US
Mailing Address - Phone:770-688-9397
Mailing Address - Fax:770-538-1127
Practice Address - Street 1:855 MOUNT VERNON HWY NE
Practice Address - Street 2:#100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4249
Practice Address - Country:US
Practice Address - Phone:770-688-9397
Practice Address - Fax:770-538-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty