Provider Demographics
NPI:1619237617
Name:NOLLEY, AMBER MICHELLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MICHELLE
Last Name:NOLLEY
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 1:2825 WILLOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7063
Mailing Address - Country:US
Mailing Address - Phone:214-364-1891
Mailing Address - Fax:
Practice Address - Street 1:2825 WILLOW RIDGE CIR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7063
Practice Address - Country:US
Practice Address - Phone:214-364-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor