Provider Demographics
NPI:1578582375
Name:KELLY, DIANE SALMON (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:SALMON
Last Name:KELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1460 RITCHIE HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2730
Mailing Address - Country:US
Mailing Address - Phone:410-757-8989
Mailing Address - Fax:410-757-9139
Practice Address - Street 1:1460 RITCHIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2730
Practice Address - Country:US
Practice Address - Phone:410-757-8989
Practice Address - Fax:410-757-9139
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59571/496LMedicare ID - Type Unspecified