MEDICARE: DR. JANINE DIANE 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	X008030	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P1107205	OTHER	NY	OXFORD
2	X06B11	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1518904770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANINE DIANE KELLY D.C.

Provider Business Mailing Address
First Line	:	1762 NEWBRIDGE RD
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1635
Country	:	US
Telephone Number	:	516-221-7258
Fax Number	:	516-221-2212

Provider Business Practice Location Address
First Line	:	1762 NEWBRIDGE RD
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1635
Country	:	US
Telephone Number	:	516-409-0044
Fax Number	:	516-221-2212

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	06/27/2022

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