Provider Demographics
NPI:1730737529
Name:KELLY, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8199 SOUTHPARK LN STE 150
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5669
Mailing Address - Country:US
Mailing Address - Phone:720-287-4853
Mailing Address - Fax:
Practice Address - Street 1:8199 SOUTHPARK LN STE 150
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5669
Practice Address - Country:US
Practice Address - Phone:231-878-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010837111N00000X
COCHR.0008825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor