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General NPI Number Information
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NPI Number | 1710533591
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Entity Type | Organization
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Legal Business Name | SHANE KELLY, D.C., LLC
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 10803 VISTA SORRENTO PKWY STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-2792
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Country | US
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Telephone | 619-777-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 10803 VISTA SORRENTO PKWY STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-2792
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Country | US
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Telephone | 619-777-3019
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | SHANE P KELLY
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Credential |
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Telephone | 619-777-3019
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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 |
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License Number State |
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