Provider Demographics
NPI:1194049080
Name:WORSTER, KELLY ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:WORSTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:WORSTER
Other - Last Name:SUTHERBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 WESTERN AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2457
Mailing Address - Country:US
Mailing Address - Phone:207-838-5643
Mailing Address - Fax:207-221-1912
Practice Address - Street 1:222 SAINT JOHN ST STE 308
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3067
Practice Address - Country:US
Practice Address - Phone:207-838-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor