Provider Demographics
NPI:1134264047
Name:CHEW, KERRILYN (DOM)
Entity type:Individual
Prefix:MS
First Name:KERRILYN
Middle Name:
Last Name:CHEW
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 32334
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-2334
Mailing Address - Country:US
Mailing Address - Phone:505-986-9109
Mailing Address - Fax:505-989-3221
Practice Address - Street 1:618 PASEO DE PERALTA STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1984
Practice Address - Country:US
Practice Address - Phone:505-986-9109
Practice Address - Fax:505-989-3221
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM649171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist