Provider Demographics
NPI:1306836440
Name:CROOKS, KELLY WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:WAYNE
Last Name:CROOKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:382 W CHESTNUT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4642
Mailing Address - Country:US
Mailing Address - Phone:724-225-1655
Mailing Address - Fax:724-225-6670
Practice Address - Street 1:382 W CHESTNUT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4642
Practice Address - Country:US
Practice Address - Phone:724-225-1655
Practice Address - Fax:724-225-6670
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001731L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor