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General NPI Number Information
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NPI Number | 1396914388
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Entity Type | Individual
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Provider Name | JENNIFER LYNN KELLY D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 8240 N TELEGRAPH RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1435
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Country | US
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Telephone | 313-724-8638
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Fax | 313-724-8926
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Provider Business Mailing Address
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Address Line | 1039 WASHINGTON ST STE 2
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City | DEARBORN
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State | MI
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Zip | 48124-2016
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Country | US
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Telephone | 734-260-1895
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Fax | 313-724-8926
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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 | 2301009418
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License Number State | MI
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