Provider Demographics
NPI:1265057392
Name:KANE, KELLY ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ELIZABETH
Last Name:KANE
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 1:621 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5141
Mailing Address - Country:US
Mailing Address - Phone:772-879-8080
Mailing Address - Fax:772-879-5808
Practice Address - Street 1:621 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5141
Practice Address - Country:US
Practice Address - Phone:772-879-8080
Practice Address - Fax:772-879-5808
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor