Provider Demographics
NPI:1477155448
Name:NEAVES, KATIEANNE NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATIEANNE
Middle Name:NICOLE
Last Name:NEAVES
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 1:1103 RIVERY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3056
Mailing Address - Country:US
Mailing Address - Phone:512-887-1477
Mailing Address - Fax:
Practice Address - Street 1:1103 RIVERY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3056
Practice Address - Country:US
Practice Address - Phone:512-887-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor