Provider Demographics
NPI:1215689765
Name:KOHUTEK, CHELSEA MAE (DC)
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:MAE
Last Name:KOHUTEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W MAGNOLIA AVE APT 516
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7703
Mailing Address - Country:US
Mailing Address - Phone:830-203-8997
Mailing Address - Fax:
Practice Address - Street 1:517 N CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5484
Practice Address - Country:US
Practice Address - Phone:214-518-6319
Practice Address - Fax:214-518-6396
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor