Provider Demographics
NPI:1689736159
Name:KELLY, WILLIAM P (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:2900 PACKARD RD
Mailing Address - Street 2:STE 2
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2061
Mailing Address - Country:US
Mailing Address - Phone:734-677-0111
Mailing Address - Fax:734-677-0135
Practice Address - Street 1:105 S PEARL ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1951
Practice Address - Country:US
Practice Address - Phone:517-423-3600
Practice Address - Fax:517-423-1452
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2301009278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor