Provider Demographics
NPI:1982847521
Name:KELLY J DOWNES DC PLLC
Entity Type:Organization
Organization Name:KELLY J DOWNES DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:631-725-2018
Mailing Address - Street 1:1626 SAGG ROAD
Mailing Address - Street 2:PO BOX 1229
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0044
Mailing Address - Country:US
Mailing Address - Phone:631-725-2018
Mailing Address - Fax:631-725-2018
Practice Address - Street 1:1626 SAGG RD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3935
Practice Address - Country:US
Practice Address - Phone:631-725-2018
Practice Address - Fax:631-725-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0107201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty