Provider Demographics
NPI:1386778157
Name:BUCHHOLZ, KELLY NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NICOLE
Last Name:BUCHHOLZ
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 1:535 JOE B JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7109
Mailing Address - Country:US
Mailing Address - Phone:615-796-1493
Mailing Address - Fax:
Practice Address - Street 1:1410 KENSINGTON SQUARE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-6902
Practice Address - Country:US
Practice Address - Phone:615-217-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3972173Medicare ID - Type UnspecifiedCHIROPRACTOR