Self Actualization Kinesiology

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2831 Issued in GA

Legal business name

SELF ACTUALIZATION KINESIOLOGY

Practice address

455 East Paces Ferry Road
325
Atlanta, GA 30305

Phone

(404) 261-7504

Fax

(404) 477-3291

NPI assigned

May 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edward Lindsey Frey, DCNPI 1265654644

Title

President

Phone

(404) 261-7504

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Lindsey Frey, DC

  • Chiropractor
  • Atlanta, GA
  • NPI 1265654644
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760694483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 EAST PACES FERRY ROAD",
            "address_2": "325",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-261-7504",
            "fax_number": "404-477-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 EAST PACES FERRY ROAD",
            "address_2": "325",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-261-7504",
            "fax_number": "404-477-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF ACTUALIZATION KINESIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FREY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "LINDSEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-261-7504",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "2831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.