Provider Demographics
NPI:1326058652
Name:DONNA M KELLY DC PC
Entity Type:Organization
Organization Name:DONNA M KELLY DC PC
Other - Org Name:KELLY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR PRES
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-792-5050
Mailing Address - Street 1:36410 GARFIELD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1131
Mailing Address - Country:US
Mailing Address - Phone:586-792-5050
Mailing Address - Fax:586-792-5298
Practice Address - Street 1:36410 GARFIELD
Practice Address - Street 2:KELLY CHIROPRACTIC
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1131
Practice Address - Country:US
Practice Address - Phone:586-792-5050
Practice Address - Fax:586-792-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25906Medicare UPIN
MI0E05241Medicare ID - Type Unspecified