Provider Demographics
NPI:1558006361
Name:MINDER, KELLIE ELAINE
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:ELAINE
Last Name:MINDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5168
Mailing Address - Country:US
Mailing Address - Phone:336-270-4642
Mailing Address - Fax:336-419-4418
Practice Address - Street 1:2855 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5168
Practice Address - Country:US
Practice Address - Phone:336-270-4642
Practice Address - Fax:336-419-4418
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor