1992995385 NPI number — KELLY CHIROPRACTIC P C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992995385 NPI number — KELLY CHIROPRACTIC P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELLY CHIROPRACTIC P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992995385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9390 FORD AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND HILL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31324-6418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-756-8080
Provider Business Mailing Address Fax Number:
912-756-8170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9390 FORD AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31324-6418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-756-8080
Provider Business Practice Location Address Fax Number:
912-756-8170
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FINDLEY
Authorized Official First Name:
PAM
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CERTIFIED CHIROPRACTIC ASSISTANT
Authorized Official Telephone Number:
912-756-8080

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6850 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GRP6134 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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