Provider Demographics
NPI:1528306867
Name:PERONA, KELLY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:PERONA
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 1:417 E PINE ST
Mailing Address - Street 2:SUITE P
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2395
Mailing Address - Country:US
Mailing Address - Phone:206-851-2242
Mailing Address - Fax:
Practice Address - Street 1:417 E PINE ST
Practice Address - Street 2:SUITE P
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2395
Practice Address - Country:US
Practice Address - Phone:206-851-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60308068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor