Provider Demographics
NPI:1841705332
Name:DR KELLYS HOUSE CALLS
Entity type:Organization
Organization Name:DR KELLYS HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-287-0903
Mailing Address - Street 1:S57W29735 SAYLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9036
Mailing Address - Country:US
Mailing Address - Phone:262-287-0903
Mailing Address - Fax:
Practice Address - Street 1:S57W29735 SAYLESVILLE RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-9036
Practice Address - Country:US
Practice Address - Phone:262-287-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3919-012261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38947400Medicaid