Provider Demographics
NPI:1912500042
Name:POWELL, CALEB JAMES
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JAMES
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 MARKETPLACE AVE APT 116
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6624
Mailing Address - Country:US
Mailing Address - Phone:334-320-5462
Mailing Address - Fax:
Practice Address - Street 1:187A KIRKHAM CIR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-8941
Practice Address - Country:US
Practice Address - Phone:512-405-0400
Practice Address - Fax:512-405-0403
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor