MEDICARE: DR. RONALD C KELLY D.C., Q.M.E.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC25456	CA

General Provider Information

NPI Number	:	1326263070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD C KELLY D.C., Q.M.E.

Provider Business Mailing Address
First Line	:	3801 S HARBOR BLVD
Second Line	:	SUITE B
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7901
Country	:	US
Telephone Number	:	714-751-5555
Fax Number	:	714-751-9999

Provider Business Practice Location Address
First Line	:	3801 S HARBOR BLVD
Second Line	:	SUITE B
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7901
Country	:	US
Telephone Number	:	714-751-5555
Fax Number	:	714-751-9999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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