Provider Demographics
NPI:1689781528
Name:KELLEY, JOSEPH ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
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 1:12305 120TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6921
Mailing Address - Country:US
Mailing Address - Phone:425-820-2777
Mailing Address - Fax:425-821-5528
Practice Address - Street 1:12305 120TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6921
Practice Address - Country:US
Practice Address - Phone:425-820-2777
Practice Address - Fax:425-821-5528
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0129284OtherDEPT OF LABOR AND INDUSTR
WAKE7942OtherREGENCE RYDER
G8856741Medicare PIN
WA0129284OtherDEPT OF LABOR AND INDUSTR