Provider Demographics
NPI:1467537316
Name:KELLY, RICHARD K (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:KELLY
Suffix:
Gender:M
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:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932
Mailing Address - Country:US
Mailing Address - Phone:631-537-8187
Mailing Address - Fax:631-537-5242
Practice Address - Street 1:39 SAWASETT AVENUE
Practice Address - Street 2:
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932
Practice Address - Country:US
Practice Address - Phone:631-537-8187
Practice Address - Fax:631-537-5242
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005778111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U1810892Medicare UPIN
NYX40181Medicare ID - Type Unspecified