Healthcare Provider Details

I. General information

NPI: 1134253495
Provider Name (Legal Business Name): KELLY A FALLON DC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N SANDBURG TER SUITE 101
CHICAGO IL
60610-2075
US

IV. Provider business mailing address

1360 N SANDBURG TER
CHICAGO IL
60610-2075
US

V. Phone/Fax

Practice location:
  • Phone: 312-944-4653
  • Fax: 312-944-0747
Mailing address:
  • Phone: 312-944-4653
  • Fax: 312-944-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. KELLY ANN FALLON
Title or Position: OWNER
Credential: DC
Phone: 630-881-9183