Provider Demographics
NPI:1285703710
Name:VON-SCHILLING WORTH, KELLY G (DC, FIACN, DACAN)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:G
Last Name:VON-SCHILLING WORTH
Suffix:
Gender:M
Credentials:DC, FIACN, DACAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44415
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-7008
Mailing Address - Country:US
Mailing Address - Phone:262-770-7014
Mailing Address - Fax:
Practice Address - Street 1:6211 DURAND AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:262-898-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010349111NN0400X
WI4264-12111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology