Provider Demographics
NPI:1427239599
Name:RENTON, KELLEY (DC)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:RENTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:ALFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5719 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8354
Mailing Address - Country:US
Mailing Address - Phone:850-512-4592
Mailing Address - Fax:
Practice Address - Street 1:8178 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6906
Practice Address - Country:US
Practice Address - Phone:850-969-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor