Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2852 | MA |
NPI | 1003018706 |
---|---|
Provider Name | Dr. Kevin J Kelley |
First Address | Springfield, MA 01104-2394 |
Second Address | Springfield, MA 01104-2394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |