Provider Demographics
NPI:1295340735
Name:SKELLY, KACEY JO (DC)
Entity type:Individual
Prefix:DR
First Name:KACEY
Middle Name:JO
Last Name:SKELLY
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 1:3819 4 MILE RD N STE B
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-9344
Mailing Address - Country:US
Mailing Address - Phone:231-421-7251
Mailing Address - Fax:
Practice Address - Street 1:3819 4 MILE RD N STE B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9344
Practice Address - Country:US
Practice Address - Phone:231-421-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3702111N00000X
MI2301401536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor