Provider Demographics
NPI:1558466151
Name:KELLY, RAE FRANCIS (BS,DC)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:FRANCIS
Last Name:KELLY
Suffix:
Gender:M
Credentials:BS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1405 ARVILLE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0539
Mailing Address - Country:US
Mailing Address - Phone:702-870-9200
Mailing Address - Fax:702-870-9219
Practice Address - Street 1:1405 ARVILLE ST
Practice Address - Street 2:STE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0539
Practice Address - Country:US
Practice Address - Phone:702-870-9200
Practice Address - Fax:702-870-9219
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVB-300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT674961Medicare UPIN