Provider Demographics
NPI:1346312287
Name:KELLY A. DELOREY, D.C., INC.
Entity Type:Organization
Organization Name:KELLY A. DELOREY, D.C., INC.
Other - Org Name:THE VILLAGE CHIROPRACTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELOREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-246-2888
Mailing Address - Street 1:484 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3140
Mailing Address - Country:US
Mailing Address - Phone:781-246-2888
Mailing Address - Fax:781-246-2899
Practice Address - Street 1:484 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3140
Practice Address - Country:US
Practice Address - Phone:781-246-2888
Practice Address - Fax:781-246-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39802OtherBCBS OF MA GROUP ID
MA11010434AAMedicaid
MAY39802OtherBCBS OF MA GROUP ID
MAY49161Medicare ID - Type UnspecifiedMEDICARE GROUP ID
MAU64320Medicare UPIN