Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 14438 | TX |
NPI | 1134742125 |
---|---|
Provider Name | Dr. Kayla Keck |
First Address | Frisco, TX 75033-2031 |
Second Address | Frisco, TX 75033-2031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2020 |
Last Update Date | 25/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14438 | LICENSE NUMBER (01) | TX |