MEDICARE: DR. MATTHEW THOMAS KELLY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR008136	GA
2	111N00000X	Chiropractor	5124	KY

General Provider Information

NPI Number	:	1194864298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW THOMAS KELLY D.C.

Provider Business Mailing Address
First Line	:	8861 SENTRY DR
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-8000
Country	:	US
Telephone Number	:	678-849-8767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 DIXIE HWY
Second Line	:
City	:	ELSMERE
State	:	KY
Zip	:	41018-1813
Country	:	US
Telephone Number	:	859-727-6888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	05/28/2008

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