Provider Demographics
NPI:1437429891
Name:HOUDESHELL, CALLIE (DC)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:HOUDESHELL
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 1:318 MAIN AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PLATTE
Mailing Address - State:SD
Mailing Address - Zip Code:57369-2120
Mailing Address - Country:US
Mailing Address - Phone:605-337-3102
Mailing Address - Fax:605-337-3104
Practice Address - Street 1:318 MAIN AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2120
Practice Address - Country:US
Practice Address - Phone:605-337-3102
Practice Address - Fax:605-337-3104
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor