Provider Demographics
NPI:1417974353
Name:CROMARTY, KELLY S (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:S
Last Name:CROMARTY
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 1:24801 5 MILE RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3655
Mailing Address - Country:US
Mailing Address - Phone:313-387-8122
Mailing Address - Fax:313-387-8123
Practice Address - Street 1:24801 5 MILE RD
Practice Address - Street 2:SUITE 22
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3655
Practice Address - Country:US
Practice Address - Phone:313-387-8122
Practice Address - Fax:313-387-8123
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4440570Medicaid
MI4440570Medicaid