Provider Demographics
NPI:1255348603
Name:KELLY, JOHN I (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:I
Last Name:KELLY
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 1:5461 BELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2525
Mailing Address - Country:US
Mailing Address - Phone:770-928-8800
Mailing Address - Fax:770-928-8811
Practice Address - Street 1:5461 BELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2525
Practice Address - Country:US
Practice Address - Phone:770-928-8800
Practice Address - Fax:770-928-8811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1565111N00000X
OH828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor