Provider Demographics
NPI:1134329527
Name:KELLY, DANIELLE DAMELIO (DC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DAMELIO
Last Name:KELLY
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 1:2 CHANGEBRIDGE RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-8947
Mailing Address - Country:US
Mailing Address - Phone:908-432-4334
Mailing Address - Fax:
Practice Address - Street 1:2 CHANGEBRIDGE RD UNIT F
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8947
Practice Address - Country:US
Practice Address - Phone:908-432-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC06031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU93859Medicare UPIN
NJ067035Medicare PIN