MEDICARE: DR. SEAN C KILGORE D.C., RN

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	163W00000X	Registered Nurse	872361	TX
2	363LF0000X	Family Nurse Practitioner	AP143125	TX
3	111N00000X	Chiropractor	8704	TX

General Provider Information

NPI Number	:	1871559138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN C KILGORE D.C., RN

Provider Business Mailing Address
First Line	:	1667 CHESTERWOOD DR
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75032-7378
Country	:	US
Telephone Number	:	972-722-0465
Fax Number	:	972-722-0465

Provider Business Practice Location Address
First Line	:	3501 SHEPHERD LN
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180
Country	:	US
Telephone Number	:	972-362-2227
Fax Number	:	972-362-2228

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	09/19/2019

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