Provider Demographics
NPI:1275633026
Name:KELLY, DALE RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:RAY
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1625 E PRATER WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8969
Mailing Address - Country:US
Mailing Address - Phone:775-358-6824
Mailing Address - Fax:775-358-6843
Practice Address - Street 1:1625 E PRATER WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8969
Practice Address - Country:US
Practice Address - Phone:775-358-6824
Practice Address - Fax:775-358-6843
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVB00385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34244Medicare ID - Type Unspecified