Provider Demographics
NPI:1992977219
Name:KELLY-FERRIS, BARBARA ANN
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:KELLY-FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4200 WOODCREEK DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6100
Mailing Address - Country:US
Mailing Address - Phone:734-528-5040
Mailing Address - Fax:
Practice Address - Street 1:4200 WOODCREEK DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6100
Practice Address - Country:US
Practice Address - Phone:734-528-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION56470Medicare UPIN
MIT33670Medicare PIN