Provider Demographics
NPI:1730211210
Name:BARRON, KELLY BETH (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BETH
Last Name:BARRON
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 1:1493 OLDENBURG DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29429-4965
Mailing Address - Country:US
Mailing Address - Phone:303-668-8428
Mailing Address - Fax:
Practice Address - Street 1:895 ISLAND PARK DR STE A
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7991
Practice Address - Country:US
Practice Address - Phone:843-696-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4685111N00000X
SC3973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3973Medicaid