Provider Demographics
NPI:1710487400
Name:KELLEY, KAREN RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RAE
Last Name:KELLEY
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 1:10200 COUNTY ROAD 65
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-4154
Mailing Address - Country:US
Mailing Address - Phone:251-943-8883
Mailing Address - Fax:
Practice Address - Street 1:10200 COUNTY ROAD 65
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-4154
Practice Address - Country:US
Practice Address - Phone:251-943-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty