Provider Demographics
NPI:1376853440
Name:SARAH K KELLY DC LLC
Entity Type:Organization
Organization Name:SARAH K KELLY DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-246-6611
Mailing Address - Street 1:600 HILLGROVE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1475
Mailing Address - Country:US
Mailing Address - Phone:708-246-6611
Mailing Address - Fax:708-246-6689
Practice Address - Street 1:600 HILLGROVE AVE STE 3
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1475
Practice Address - Country:US
Practice Address - Phone:708-246-6611
Practice Address - Fax:708-246-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU76021Medicare UPIN
IL205075Medicare PIN