Provider Demographics
NPI:1558061358
Name:LEWIS, KAILLYN DEMOURY (DC)
Entity Type:Individual
Prefix:
First Name:KAILLYN
Middle Name:DEMOURY
Last Name:LEWIS
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 1:4623 KILMARNOCH WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2727
Mailing Address - Country:US
Mailing Address - Phone:281-513-4433
Mailing Address - Fax:
Practice Address - Street 1:27120 FULSHEAR BEND DR STE 300
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1191
Practice Address - Country:US
Practice Address - Phone:346-998-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor