MEDICARE: KELLY J TOWNE DC

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	2666	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447242193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J TOWNE DC

Provider Business Mailing Address
First Line	:	105 CLARMAR DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2675
Country	:	US
Telephone Number	:	608-318-5929
Fax Number	:	608-318-5922

Provider Business Practice Location Address
First Line	:	700 HWY 69 S
Second Line	:
City	:	NEW GLARUS
State	:	WI
Zip	:	53574-0396
Country	:	US
Telephone Number	:	608-527-2715
Fax Number	:	608-527-5796

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/05/2024

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