Provider Demographics
NPI:1730587221
Name:KELLY WORSTER DC, LLC
Entity type:Organization
Organization Name:KELLY WORSTER DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-838-5643
Mailing Address - Street 1:260 WESTERN AVE, SUITE 209
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-838-5643
Mailing Address - Fax:207-221-1912
Practice Address - Street 1:260 WESTERN AVE, SUITE 209
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-838-5643
Practice Address - Fax:207-221-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty