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General NPI Number Information
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NPI Number | 1881823730
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Entity Type | Organization
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Legal Business Name | KELLY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 09/27/2013
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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 | 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 | 734-206-1895
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Fax | 313-724-8926
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Authorized Official
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Title or Position | CEO
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Name | DR. JENNIFER LYNN KELLY
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Credential | D.C.
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Telephone | 734-260-1895
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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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