Provider Demographics
NPI:1023082724
Name:SMITH, KELLY DENISE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DENISE
Last Name:SMITH
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 1:4709 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 124
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2914
Mailing Address - Country:US
Mailing Address - Phone:972-625-4800
Mailing Address - Fax:972-625-5028
Practice Address - Street 1:4709 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 124
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2914
Practice Address - Country:US
Practice Address - Phone:972-625-4800
Practice Address - Fax:972-625-5028
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3860OtherBLUE CROSS BLUE SHIELD
TX8H3860OtherBLUE CROSS BLUE SHIELD
TXU48291Medicare UPIN