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General NPI Number Information
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NPI Number | 1770566762
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Entity Type | Organization
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Legal Business Name | JUDY L KELLY PC
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 1925 E BELT LINE RD #503
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City | CARROLLTON
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State | TX
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Zip | 75006-5801
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Country | US
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Telephone | 972-242-3080
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Fax | 972-242-2071
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Provider Business Mailing Address
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Address Line | 1925 E BELT LINE RD #503
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City | CARROLLTON
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State | TX
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Zip | 75006-5801
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Country | US
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Telephone | 972-242-3080
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Fax | 972-242-2071
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. JUDY KELLY
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Credential | DC
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Telephone | 972-242-3080
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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 | 5277
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License Number State | TX
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