Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 0104557011 | VA |
Y | 111NR0400X | Rehabilitation Chiropractor | 038.012687 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | S03721 | MD |
NPI | 1306199047 |
---|---|
Provider Name | Kelly Opron |
First Address | Oak Park, IL 60304-1679 |
Second Address | Oak Park, IL 60304-1679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 10/12/2014 |