Provider Demographics
NPI:1043229032
Name:KULOW, KELLIE LYNETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:LYNETTE
Last Name:KULOW
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 1:218 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-3780
Mailing Address - Country:US
Mailing Address - Phone:979-830-7055
Mailing Address - Fax:979-836-8168
Practice Address - Street 1:218 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-3780
Practice Address - Country:US
Practice Address - Phone:979-830-7055
Practice Address - Fax:979-836-8168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor