Provider Demographics
NPI:1194820985
Name:HELMS, KELLY L (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HELMS
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 1:1804 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938
Mailing Address - Country:US
Mailing Address - Phone:217-235-3100
Mailing Address - Fax:217-235-3104
Practice Address - Street 1:1804 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-3806
Practice Address - Country:US
Practice Address - Phone:217-235-3100
Practice Address - Fax:217-235-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350049692OtherRR MEDICARE
IL038008909Medicaid
IL01526215OtherBLUE CROSS BLUE SHIELD
IL01526215OtherBLUE CROSS BLUE SHIELD
IL038008909Medicaid