Provider Demographics
NPI:1295862894
Name:OZMON, KELLE R (DC)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:R
Last Name:OZMON
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 1:449 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5031
Mailing Address - Country:US
Mailing Address - Phone:941-729-5727
Mailing Address - Fax:941-729-5679
Practice Address - Street 1:449 10TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5031
Practice Address - Country:US
Practice Address - Phone:941-729-5727
Practice Address - Fax:941-729-5679
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor