Provider Demographics
NPI:1912250622
Name:DILLON, KETREA D (DC)
Entity Type:Individual
Prefix:DR
First Name:KETREA
Middle Name:D
Last Name:DILLON
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 1:11139 HILLSIDE GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5023
Mailing Address - Country:US
Mailing Address - Phone:713-702-8128
Mailing Address - Fax:
Practice Address - Street 1:12020 FM 1960 RD W
Practice Address - Street 2:STE 980
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5363
Practice Address - Country:US
Practice Address - Phone:281-517-0800
Practice Address - Fax:281-517-0803
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor