Provider Demographics
NPI:1851606495
Name:O'NEILL, KELLY ERIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ERIN
Last Name:O'NEILL
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 1:1833 N HUDSON AVE
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7984
Mailing Address - Country:US
Mailing Address - Phone:843-469-5644
Mailing Address - Fax:
Practice Address - Street 1:24W500 MAPLE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6055
Practice Address - Country:US
Practice Address - Phone:630-428-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3574111N00000X
IL038012154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor