MEDICARE: DR. LEA KELLEY D.C., L.AC.

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	DC 24997	CA
2	171100000X	Acupuncturist	AC 9444	CA

General Provider Information

NPI Number	:	1598920498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEA KELLEY D.C., L.AC.

Provider Business Mailing Address
First Line	:	3214 HIGHLAND AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3833
Country	:	US
Telephone Number	:	310-545-6528
Fax Number	:	310-545-6537

Provider Business Practice Location Address
First Line	:	3214 HIGHLAND AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3833
Country	:	US
Telephone Number	:	310-545-6528
Fax Number	:	310-545-6537

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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