Provider Demographics
NPI:1891129359
Name:NICHOLS, KEILA KAYE (DC)
Entity Type:Individual
Prefix:DR
First Name:KEILA
Middle Name:KAYE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KEILA
Other - Middle Name:RICHARDSON
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3207 ABINGDON DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4086
Mailing Address - Country:US
Mailing Address - Phone:214-986-3839
Mailing Address - Fax:
Practice Address - Street 1:3207 ABINGDON DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4086
Practice Address - Country:US
Practice Address - Phone:214-986-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor