MEDICARE: JULIA LYNN KELLEY 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	038.013639	IL

General Provider Information

NPI Number	:	1982200044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA LYNN KELLEY DC

Provider Business Mailing Address
First Line	:	0S863 THORNDON RIDGE DR
Second Line	:
City	:	ELBURN
State	:	IL
Zip	:	60119-9653
Country	:	US
Telephone Number	:	256-655-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	0S863 THORNDON RIDGE DR
Second Line	:
City	:	ELBURN
State	:	IL
Zip	:	60119-9653
Country	:	US
Telephone Number	:	256-655-0140
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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