Provider Demographics
NPI:1053656785
Name:KELLY, MATTHEW E (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 STONE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2415
Mailing Address - Country:US
Mailing Address - Phone:585-225-6430
Mailing Address - Fax:585-225-9636
Practice Address - Street 1:1851 STONE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2415
Practice Address - Country:US
Practice Address - Phone:585-225-6430
Practice Address - Fax:585-225-9636
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor