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General NPI Number Information
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NPI Number | 1346782380
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Entity Type | Organization
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Legal Business Name | NEELY CHIROPRACTIC & SPORT, PLLC.
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 1666 N HAMPTON RD SUITE 111
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City | DESOTO
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State | TX
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Zip | 75115-2390
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Country | US
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Telephone | 469-547-2032
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Fax |
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Provider Business Mailing Address
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Address Line | 1666 N HAMPTON RD SUITE 111
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City | DESOTO
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State | TX
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Zip | 75115-2390
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Country | US
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Telephone | 469-547-2032
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEMON NEELY
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Credential | DC
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Telephone | 469-547-2032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13101
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License Number State | TX
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