Provider Demographics
NPI:1104844430
Name:ANELLO, KELLY J (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:ANELLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-0551
Mailing Address - Country:US
Mailing Address - Phone:262-354-4136
Mailing Address - Fax:
Practice Address - Street 1:557 W 29735 SAYLESVILLE RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189
Practice Address - Country:US
Practice Address - Phone:262-287-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3919-012111N00000X
WI3919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38947400Medicaid
WI000235975Medicare ID - Type Unspecified
WI38947400Medicaid