Provider Demographics
NPI:1265299481
Name:KELLY LOW
Entity type:Organization
Organization Name:KELLY LOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-903-9208
Mailing Address - Street 1:1135 NEWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1250
Mailing Address - Country:US
Mailing Address - Phone:708-903-9208
Mailing Address - Fax:
Practice Address - Street 1:6416 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2285
Practice Address - Country:US
Practice Address - Phone:773-774-6771
Practice Address - Fax:773-774-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty