Provider Demographics
NPI:1780747105
Name:KELLEY, WILLIEM RONALD (DC)
Entity type:Individual
Prefix:MR
First Name:WILLIEM
Middle Name:RONALD
Last Name:KELLEY
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 1:7221 OAK RIDGE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2662
Mailing Address - Country:US
Mailing Address - Phone:865-693-5350
Mailing Address - Fax:865-693-5286
Practice Address - Street 1:7221 OAK RIDGE HWY STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2662
Practice Address - Country:US
Practice Address - Phone:865-693-5350
Practice Address - Fax:865-693-5286
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2005716OtherBCBS
TN621024749OtherUNITED HEALTHCARE
TN4546766OtherCIGNA