Provider Demographics
NPI:1760663181
Name:HERNANDEZ, KELLY LEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEE
Other - Last Name:CATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2512 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-8720
Mailing Address - Country:US
Mailing Address - Phone:214-497-0262
Mailing Address - Fax:
Practice Address - Street 1:2618 ELECTRONIC LN
Practice Address - Street 2:102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1216
Practice Address - Country:US
Practice Address - Phone:214-350-7708
Practice Address - Fax:214-350-2855
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor