Provider Demographics
NPI:1346314333
Name:CHEELY, KEVIN L (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:CHEELY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 N BELLWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2088
Mailing Address - Country:US
Mailing Address - Phone:618-259-3333
Mailing Address - Fax:618-259-3334
Practice Address - Street 1:131 N BELLWOOD DR STE D
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2088
Practice Address - Country:US
Practice Address - Phone:618-259-3333
Practice Address - Fax:618-259-3334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37860Medicare UPIN
IL688900Medicare PIN