Provider Demographics
NPI:1225490758
Name:HAMM, KELLYE (DC)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:
Last Name:HAMM
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 1:6200 ELDORADO PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5624
Mailing Address - Country:US
Mailing Address - Phone:972-529-9911
Mailing Address - Fax:
Practice Address - Street 1:6200 ELDORADO PKWY
Practice Address - Street 2:STE B
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5624
Practice Address - Country:US
Practice Address - Phone:972-529-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor