Provider Demographics
NPI:1871559138
Name:KILGORE, SEAN C (DC, RN)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:C
Last Name:KILGORE
Suffix:
Gender:M
Credentials:DC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1667 CHESTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7378
Mailing Address - Country:US
Mailing Address - Phone:972-722-0465
Mailing Address - Fax:972-722-0465
Practice Address - Street 1:3501 SHEPHERD LN
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180
Practice Address - Country:US
Practice Address - Phone:972-362-2227
Practice Address - Fax:972-362-2228
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX872361163W00000X
TXAP143125363LF0000X
TX8704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609746Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXU-91884Medicare UPIN