Provider Demographics
NPI:1245268192
Name:KELLEY-DUKES, ANITA F (DC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:F
Last Name:KELLEY-DUKES
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 1:1078 S FERDON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4510
Mailing Address - Country:US
Mailing Address - Phone:850-682-0381
Mailing Address - Fax:850-683-0981
Practice Address - Street 1:1078 S FERDON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4510
Practice Address - Country:US
Practice Address - Phone:850-682-0381
Practice Address - Fax:850-683-0981
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55971Medicare UPIN
FL88807ZMedicare ID - Type Unspecified