Provider Demographics
NPI:1497768378
Name:CONOVER, KELLI JO (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:JO
Last Name:CONOVER
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 1:11015 WARWICK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3225
Mailing Address - Country:US
Mailing Address - Phone:757-591-8834
Mailing Address - Fax:757-591-2542
Practice Address - Street 1:9610 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-4541
Practice Address - Country:US
Practice Address - Phone:757-591-8834
Practice Address - Fax:757-591-2542
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350037642OtherRAILROAD MEDICARE
VA321210OtherBLUE CROSS BLUE SHIELD #
VAU61750Medicare UPIN
VA350000876Medicare ID - Type Unspecified