Provider Demographics
NPI:1578664439
Name:KELLEY, ARIAN G (DC)
Entity Type:Individual
Prefix:DR
First Name:ARIAN
Middle Name:G
Last Name:KELLEY
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 1:2595 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7748
Mailing Address - Country:US
Mailing Address - Phone:910-392-1252
Mailing Address - Fax:910-392-1244
Practice Address - Street 1:2307 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-6443
Practice Address - Country:US
Practice Address - Phone:910-392-1488
Practice Address - Fax:910-392-1489
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2459642Medicare PIN