Provider Demographics
NPI:1124620927
Name:KELLY CHIROPRACTIC INC.
Entity type:Organization
Organization Name:KELLY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-594-0000
Mailing Address - Street 1:20 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2918
Mailing Address - Country:US
Mailing Address - Phone:207-594-0000
Mailing Address - Fax:207-593-7131
Practice Address - Street 1:20 SUMMER ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2918
Practice Address - Country:US
Practice Address - Phone:207-594-0000
Practice Address - Fax:207-593-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty