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NPI Code Detail

MEDICARE: DR. KELLY LARDI D.C.

MEDICARE:  DR. KELLY  LARDI  D.C.
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
1111NS0005XSports Physician Chiropractor038-007152IL

General Provider Information

NPI Number : 1407843717
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY LARDI D.C.
Provider Business Mailing Address
First Line : 495 E 1ST ST
Second Line :
City : COAL CITY
State : IL
Zip : 60416-1633
Country : US
Telephone Number : 815-634-3750
Fax Number :
Provider Business Practice Location Address
First Line : 495 E 1ST ST
Second Line :
City : COAL CITY
State : IL
Zip : 60416-1633
Country : US
Telephone Number : 815-634-3750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2005
Last Update Date : 01/06/2011

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Directions to “ DR. KELLY LARDI D.C.” Practice Location

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