Provider Demographics
NPI:1710342217
Name:NEELY, DEMON (DC)
Entity Type:Individual
Prefix:
First Name:DEMON
Middle Name:
Last Name:NEELY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 N HAMPTON RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2390
Mailing Address - Country:US
Mailing Address - Phone:469-547-2032
Mailing Address - Fax:972-957-2731
Practice Address - Street 1:1666 N HAMPTON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2390
Practice Address - Country:US
Practice Address - Phone:469-547-2032
Practice Address - Fax:972-957-2731
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor