Provider Demographics
NPI:1376642348
Name:TAYLOR-BENTZ, KELLEY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:ANN
Last Name:TAYLOR-BENTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COCASSET ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2948
Mailing Address - Country:US
Mailing Address - Phone:508-543-1866
Mailing Address - Fax:508-543-1867
Practice Address - Street 1:17 COCASSET ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2948
Practice Address - Country:US
Practice Address - Phone:508-543-1866
Practice Address - Fax:508-543-1867
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1168339OtherCIGNA
RI409959OtherBLUE CHIP RI
MA33100489OtherHCVM
MA494480OtherTUFTS
MAY36869OtherBLUE CROSS MA (Y39626)
RI23194-3OtherBLUE CROSS RI
MA351476OtherHARVARD PILGRIM
MA1168339OtherCIGNA