Provider Demographics
NPI:1346782380
Name:NEELY CHIROPRACTIC & SPORT, PLLC.
Entity Type:Organization
Organization Name:NEELY CHIROPRACTIC & SPORT, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-547-2032
Mailing Address - Street 1:1666 N HAMPTON RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2390
Mailing Address - Country:US
Mailing Address - Phone:469-547-2032
Mailing Address - Fax:
Practice Address - Street 1:1666 N HAMPTON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2390
Practice Address - Country:US
Practice Address - Phone:469-547-2032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty