Provider Demographics
NPI:1629145826
Name:BURWELL, KELLY JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JEAN
Last Name:BURWELL
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 1:3719 TARSUS RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:TN
Mailing Address - Zip Code:37142-2103
Mailing Address - Country:US
Mailing Address - Phone:931-326-9241
Mailing Address - Fax:
Practice Address - Street 1:664 SANGO RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5489
Practice Address - Country:US
Practice Address - Phone:931-368-1996
Practice Address - Fax:931-368-0448
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN133736OtherBLUE CROSS BLUE SHIELD
TN133736OtherBLUE CROSS BLUE SHIELD
TN3676220Medicare ID - Type Unspecified