Provider Demographics
NPI:1871556258
Name:THOMPSON, KELLY MCMURTREY (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MCMURTREY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:MCMURTREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:106 W STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-9403
Mailing Address - Country:US
Mailing Address - Phone:270-432-5656
Mailing Address - Fax:270-432-5658
Practice Address - Street 1:106 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-9403
Practice Address - Country:US
Practice Address - Phone:270-432-5656
Practice Address - Fax:270-432-5658
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611622826OtherTAX ID