Provider Demographics
NPI:1326263070
Name:KELLY, RONALD C (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3801 S HARBOR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7901
Mailing Address - Country:US
Mailing Address - Phone:714-751-5555
Mailing Address - Fax:714-751-9999
Practice Address - Street 1:3801 S HARBOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7901
Practice Address - Country:US
Practice Address - Phone:714-751-5555
Practice Address - Fax:714-751-9999
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor