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General NPI Number Information
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NPI Number | 1013456482
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Entity Type | Organization
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Legal Business Name | ROBERT KELLY DC LLC
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 1722 BONETA AVE
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-2453
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Country | US
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Telephone | 703-231-4609
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 BONETA AVE
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-2453
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Country | US
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Telephone | 703-231-4609
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT KELLY
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Credential | D.C.
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Telephone | 703-231-4609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2015028621
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License Number State | MO
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