Provider Demographics
NPI:1790402824
Name:KELLY, JOSEPH J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:KELLY
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 1:9693 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3771
Mailing Address - Country:US
Mailing Address - Phone:703-223-5279
Mailing Address - Fax:
Practice Address - Street 1:9693 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3771
Practice Address - Country:US
Practice Address - Phone:703-223-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor