Provider Demographics
NPI:1194034488
Name:KELLEY, GAIL DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:DUANE
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 1:4115 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1043
Mailing Address - Country:US
Mailing Address - Phone:310-944-1076
Mailing Address - Fax:
Practice Address - Street 1:4115 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1043
Practice Address - Country:US
Practice Address - Phone:562-408-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor