Provider Demographics
NPI:1144230624
Name:KELLY, SARAH KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KATHLEEN
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 1:6630 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2053
Mailing Address - Country:US
Mailing Address - Phone:727-873-7870
Mailing Address - Fax:727-954-3361
Practice Address - Street 1:6630 78TH AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2053
Practice Address - Country:US
Practice Address - Phone:727-873-7870
Practice Address - Fax:727-954-3361
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008799111N00000X
FLCH12467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205075Medicare PIN
U76021Medicare UPIN
IL599800Medicare ID - Type Unspecified