Provider Demographics
NPI:1164435392
Name:KELLEY, CHRISTOPHER KAROL (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KAROL
Last Name:KELLEY
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 1:7221 OAK RIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2661
Mailing Address - Country:US
Mailing Address - Phone:865-693-5350
Mailing Address - Fax:865-693-5286
Practice Address - Street 1:7221 OAK RIDGE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2661
Practice Address - Country:US
Practice Address - Phone:865-693-5350
Practice Address - Fax:865-693-5286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3679088Medicaid
TN3679088Medicaid
TN3679088Medicare PIN