Provider Demographics
NPI:1194921957
Name:COLLETTE, KELLY ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 W 29TH ST UNIT 510
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8339
Mailing Address - Country:US
Mailing Address - Phone:970-313-7514
Mailing Address - Fax:
Practice Address - Street 1:2711 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5422
Practice Address - Country:US
Practice Address - Phone:970-356-0525
Practice Address - Fax:970-304-1656
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor