Provider Demographics
NPI:1770573636
Name:MULHERN, KELLEY S (DC)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:S
Last Name:MULHERN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:S
Other - Last Name:PENDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4125 PARK ST N LOT 433
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4042
Mailing Address - Country:US
Mailing Address - Phone:207-899-7072
Mailing Address - Fax:
Practice Address - Street 1:4125 PARK ST N LOT 433
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4042
Practice Address - Country:US
Practice Address - Phone:207-899-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1481111N00000X
FLCH11254111N00000X
MECR1571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor