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General NPI Number Information
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NPI Number | 1922374958
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Entity Type | Organization
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Legal Business Name | KEVIN M KELLY CHIROPRACTIC INC
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 15901 HAWTHORNE BLVD SUITE 420
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City | LAWNDALE
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State | CA
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Zip | 90260-2655
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Country | US
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Telephone | 310-214-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 15901 HAWTHORNE BLVD SUITE 420
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City | LAWNDALE
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State | CA
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Zip | 90260-2655
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Country | US
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Telephone | 310-214-9555
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN MICHAEL KELLY
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Credential | DC
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Telephone | 805-496-6104
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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 | DC17725
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License Number State | CA
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