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General NPI Number Information
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NPI Number | 1124106596
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Entity Type | Individual
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Provider Name | MICHAEL DAVID KELLY DC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 132 S RIDGE AVE UNIT B
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1216
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Country | US
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Telephone | 630-893-7313
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Fax | 630-893-7453
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Provider Business Mailing Address
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Address Line | 160 S BLOOMINGDALE RD STE D
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1455
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Country | US
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Telephone | 630-893-7313
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Fax | 630-893-7453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038006619
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License Number State | IL
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