Provider Demographics
NPI:1306199047
Name:OPRON, KELLY (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:OPRON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:NOONAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:147 HARRISON ST # B
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1679
Mailing Address - Country:US
Mailing Address - Phone:708-613-0615
Mailing Address - Fax:708-294-3835
Practice Address - Street 1:147 HARRISON ST # B
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1679
Practice Address - Country:US
Practice Address - Phone:708-613-0615
Practice Address - Fax:708-294-3835
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03721111NR0400X
VA0104557011111NR0400X
IL038.012687111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation