Provider Demographics
NPI:1619391240
Name:CULLEN, KELLY (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CULLEN
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 1:231 BLUE RAVINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3893
Mailing Address - Country:US
Mailing Address - Phone:916-796-9986
Mailing Address - Fax:916-351-0776
Practice Address - Street 1:231 BLUE RAVINE RD
Practice Address - Street 2:#200
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3893
Practice Address - Country:US
Practice Address - Phone:916-796-9986
Practice Address - Fax:916-351-0076
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor