Provider Demographics
NPI:1255483855
Name:KELLOGG, KIMBERLYN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLYN
Middle Name:
Last Name:KELLOGG
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 1:5054 TABITHA ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2878
Mailing Address - Country:US
Mailing Address - Phone:615-887-6868
Mailing Address - Fax:
Practice Address - Street 1:1535 W NORTHFIELD BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1427
Practice Address - Country:US
Practice Address - Phone:615-887-6868
Practice Address - Fax:615-849-7744
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4129293OtherBCBS