Provider Demographics
NPI:1245016286
Name:KELLY, WHITNEY ROBIN (DC)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ROBIN
Last Name:KELLY
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 1:343 STANLEY BELL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5919
Mailing Address - Country:US
Mailing Address - Phone:561-436-6766
Mailing Address - Fax:
Practice Address - Street 1:343 STANLEY BELL DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5919
Practice Address - Country:US
Practice Address - Phone:561-436-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor