Provider Demographics
NPI:1194703850
Name:KELLY, PATRICK J JR (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 E OTTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2509
Mailing Address - Country:US
Mailing Address - Phone:724-838-7700
Mailing Address - Fax:724-838-7200
Practice Address - Street 1:125 E OTTERMAN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2509
Practice Address - Country:US
Practice Address - Phone:724-838-7700
Practice Address - Fax:724-838-7200
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007119L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01681801Medicaid
U69786Medicare UPIN
PA006619N9MMedicare PIN