Provider Demographics
NPI:1740203298
Name:KELLY, MICHAEL TAYLOR (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TAYLOR
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 YAM GANDY RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2546
Mailing Address - Country:US
Mailing Address - Phone:912-598-8901
Mailing Address - Fax:
Practice Address - Street 1:102 YAM GANDY RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-2546
Practice Address - Country:US
Practice Address - Phone:912-598-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor