Provider Demographics
NPI:1790776367
Name:TRIPLETT-KESKY, TAMMY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LYNN
Last Name:TRIPLETT-KESKY
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 1:712 VILLAGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-3412
Mailing Address - Country:US
Mailing Address - Phone:910-755-5400
Mailing Address - Fax:910-755-5402
Practice Address - Street 1:712 VILLAGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-3412
Practice Address - Country:US
Practice Address - Phone:910-755-5400
Practice Address - Fax:910-755-5402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3306111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2457437Medicare ID - Type UnspecifiedMEDICARE
NCU41859Medicare UPIN