Provider Demographics
NPI:1497185235
Name:KELLY, IAN SETH DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:SETH DAVID
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 1:5710 S MILAM ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3210
Mailing Address - Country:US
Mailing Address - Phone:806-676-2007
Mailing Address - Fax:806-803-9663
Practice Address - Street 1:7201 W I 40 STE 210
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2634
Practice Address - Country:US
Practice Address - Phone:806-337-2084
Practice Address - Fax:806-803-9663
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor