Provider Demographics
NPI:1790079671
Name:KELLY, LORIEN (DO)
Entity Type:Individual
Prefix:DR
First Name:LORIEN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LORIEN
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:43 W FRONT ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1624
Mailing Address - Country:US
Mailing Address - Phone:732-576-8998
Mailing Address - Fax:732-576-9920
Practice Address - Street 1:43 W FRONT ST
Practice Address - Street 2:SUITE 8
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1624
Practice Address - Country:US
Practice Address - Phone:732-576-8998
Practice Address - Fax:732-576-9920
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00500600111N00000X
NY70 008308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor