Provider Demographics
NPI:1528395407
Name:DUNN, MICHELLE KRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KRISTINE
Last Name:DUNN
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 1:4055 HOGAN DR APT 3003
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75709-6957
Mailing Address - Country:US
Mailing Address - Phone:612-237-0030
Mailing Address - Fax:
Practice Address - Street 1:1816 S MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7707
Practice Address - Country:US
Practice Address - Phone:903-882-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor