Provider Demographics
NPI:1134585144
Name:CALLAWAY, KELLY J (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:CALLAWAY
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 1:2067 MAHANEY AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5731
Mailing Address - Country:US
Mailing Address - Phone:918-708-2563
Mailing Address - Fax:918-456-3000
Practice Address - Street 1:2067 MAHANEY AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5731
Practice Address - Country:US
Practice Address - Phone:918-708-2563
Practice Address - Fax:918-456-3000
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4396111N00000X, 111N00000X
KS01-05763111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor