Provider Demographics
NPI:1982200044
Name:KELLEY, JULIA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNN
Last Name:KELLEY
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 1:0S863 THORNDON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9653
Mailing Address - Country:US
Mailing Address - Phone:256-655-0140
Mailing Address - Fax:
Practice Address - Street 1:0S863 THORNDON RIDGE DR
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-9653
Practice Address - Country:US
Practice Address - Phone:256-655-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor