Provider Demographics
NPI:1760564397
Name:MINICUCCI, KELLY MAE (DC, FIAMA)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MAE
Last Name:MINICUCCI
Suffix:
Gender:F
Credentials:DC, FIAMA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10268 W CENTENNIAL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6423
Mailing Address - Country:US
Mailing Address - Phone:303-949-5106
Mailing Address - Fax:303-948-0772
Practice Address - Street 1:10268 W CENTENNIAL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6423
Practice Address - Country:US
Practice Address - Phone:303-949-5106
Practice Address - Fax:303-948-0772
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO5614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor