Provider Demographics
NPI:1538682455
Name:PARIS, KALLI MARELLE (DC)
Entity Type:Individual
Prefix:
First Name:KALLI
Middle Name:MARELLE
Last Name:PARIS
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 1:1111 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3601
Mailing Address - Country:US
Mailing Address - Phone:234-203-1105
Mailing Address - Fax:
Practice Address - Street 1:1111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-3601
Practice Address - Country:US
Practice Address - Phone:234-203-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1538682455OtherOHIO STATE BOARD