Provider Demographics
NPI:1902277346
Name:KELLYS CHIROPRACTIC
Entity Type:Organization
Organization Name:KELLYS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAEYDA
Authorized Official - Middle Name:PATREICE
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:862-371-7059
Mailing Address - Street 1:1362 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3342
Mailing Address - Country:US
Mailing Address - Phone:908-688-4055
Mailing Address - Fax:
Practice Address - Street 1:1362 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3342
Practice Address - Country:US
Practice Address - Phone:908-688-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00703700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty