Provider Demographics
NPI:1649333832
Name:KELLY, DANIEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
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 1:26 BRIGHTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4043
Mailing Address - Country:US
Mailing Address - Phone:781-552-1510
Mailing Address - Fax:
Practice Address - Street 1:26 BRIGHTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4043
Practice Address - Country:US
Practice Address - Phone:617-993-9936
Practice Address - Fax:617-993-9938
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494512OtherTUFTS HEALTH PLAN
MAAA51528OtherHARVARD PILGRIM HEALTH
MAY37098OtherBCBS OF MASS
MAKEY45813Medicare ID - Type Unspecified