Provider Demographics
NPI:1336538172
Name:GENTRY, KELLEY CATHERINE NICOLE (DC)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:CATHERINE NICOLE
Last Name:GENTRY
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 1:6000 MAIDSTONE DR
Mailing Address - Street 2:APT. 06
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-6319
Mailing Address - Country:US
Mailing Address - Phone:865-604-3934
Mailing Address - Fax:
Practice Address - Street 1:430 OAK GROVE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3902
Practice Address - Country:US
Practice Address - Phone:865-604-3934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC .4010 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor