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General NPI Number Information
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NPI Number | 1588911671
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Entity Type | Organization
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Legal Business Name | KELLEY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 1000 WILLIAM HILTON PKWY STE K100
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29928-6110
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Country | US
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Telephone | 843-321-8119
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Fax | 404-448-4493
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Provider Business Mailing Address
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Address Line | 1000 WILLIAM HILTON PKWY STE K100
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29928-6110
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Country | US
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Telephone | 843-321-8119
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Fax | 404-448-4493
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Authorized Official
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Title or Position | CEO
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Name | DR. KELLEY M LEBLANC
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Credential | D.C.
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Telephone | 843-321-8119
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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 | 3695
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License Number State | SC
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