MEDICARE: KELLIE CARO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	16868	TX

General Provider Information

NPI Number	:	1366387755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE CARO

Provider Business Mailing Address
First Line	:	4967 SHADY OAK TRL
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4967 SHADY OAK TRL
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4470
Country	:	US
Telephone Number	:	214-725-9513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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Directions to “ KELLIE CARO ” Practice Location

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