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General NPI Number Information
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NPI Number | 1184946436
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Entity Type | Individual
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Provider Name | KELLEY JO WATFORD DC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 128 SWOPE AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5833
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Country | US
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Telephone | 719-629-8333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 76204
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City | COLORADO SPRINGS
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State | CO
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Zip | 80970-6204
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Country | US
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Telephone | 719-629-8333
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Fax |
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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 | 31567
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6875
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License Number State | CO
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