Provider Demographics
NPI:1710379672
Name:DUNKLOW, KELLY WATERS
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:WATERS
Last Name:DUNKLOW
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 1:69 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2622
Mailing Address - Country:US
Mailing Address - Phone:802-662-1047
Mailing Address - Fax:
Practice Address - Street 1:69 CENTER RD
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2622
Practice Address - Country:US
Practice Address - Phone:802-662-1047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0109165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor