Colony Chiropractic PA
Organization Active NPI Chiropractor · The Colony, TX
NPI 1962698308 · NPPES record last updated Dec 15, 2020
Key facts
- NPI
- 1962698308
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6216 (TX)
- Legal business name
- COLONY CHIROPRACTIC PA
- Practice address
- 4709 State Highway 121 Ste 124
The Colony, TX 75056-2903 - Phone
- (972) 625-4800
- Fax
- (972) 625-5028
- NPI assigned
- Sep 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kelly Denise Smith, D.C.
- Title
- Owner/Chiropractor
- Phone
- (972) 625-4800
Practitioners 1
-
Kelly Denise Smith, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101110001393 | TX | Part B Supplier - Clinic/Group Practice | 4789879156 |
Receives reassigned benefits from 1 practitioner Practice locations: The Colony, TX |
National Provider Directory
Locations
5000 Main St
Ste 203
The Colony, TX 75056
Phone (972) 625-4800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 6216 | TX | Yes |
Addresses
Primary practice location
4709 State Highway 121 Ste 124
The Colony, TX 75056-2903
Mailing address
4709 State Highway 121 Ste 124
The Colony, TX 75056-2903
Phone (972) 625-4800
Other practice location 1
5000 Main St
Suite 203
The Colony, TX 75056-2238
Phone (972) 625-4800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023082724 | Other | TX | TYPE 1 NPI |
| 8H3860 | Other | TX | BLUECROSS BLUESHIELD |
| 5975391 | Other | TX | AETNA |
Other names
- Colony Chiropractic
Other providers in The Colony, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.