Provider Demographics
NPI:1811902265
Name:CHUMLEY, KELLY SUE (DC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:CHUMLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13714 GAMMA RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4469
Mailing Address - Country:US
Mailing Address - Phone:972-248-8666
Mailing Address - Fax:972-488-6988
Practice Address - Street 1:13714 GAMMA RD
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4469
Practice Address - Country:US
Practice Address - Phone:972-248-8666
Practice Address - Fax:972-488-6988
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10734967OtherCAQH
UT79021Medicare UPIN
605183Medicare ID - Type Unspecified