Provider Demographics
NPI:1598946220
Name:PORTER, KELLY E (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:E
Last Name:PORTER
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 1:12351 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7425
Mailing Address - Country:US
Mailing Address - Phone:919-556-0282
Mailing Address - Fax:919-554-0305
Practice Address - Street 1:12351 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7425
Practice Address - Country:US
Practice Address - Phone:919-556-0282
Practice Address - Fax:919-554-0305
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor