Provider Demographics
NPI:1538295480
Name:MARTIN, KELLY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:MARTIN
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 1:105 FOREST MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-3204
Mailing Address - Country:US
Mailing Address - Phone:214-282-6918
Mailing Address - Fax:
Practice Address - Street 1:4760 PRESTON RD STE 208
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8549
Practice Address - Country:US
Practice Address - Phone:972-225-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor