Provider Demographics
NPI:1649485368
Name:ROSS, KELLI MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:MICHELLE
Last Name:ROSS
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 1:2119 SEIPSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-2022
Mailing Address - Country:US
Mailing Address - Phone:717-533-6100
Mailing Address - Fax:717-534-1957
Practice Address - Street 1:158 W CARACAS AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1510
Practice Address - Country:US
Practice Address - Phone:717-533-6100
Practice Address - Fax:717-534-1957
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007767-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor