Provider Demographics
NPI:1972737088
Name:KELL, MARIA CRISTINA (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:MARIA CRISTINA
Middle Name:
Last Name:KELL
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N BENTLEY ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4578
Mailing Address - Country:US
Mailing Address - Phone:618-303-4747
Mailing Address - Fax:888-409-5536
Practice Address - Street 1:1602 N BENTLEY ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4578
Practice Address - Country:US
Practice Address - Phone:618-303-4747
Practice Address - Fax:888-409-5536
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000073171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist