Provider Demographics
NPI:1912144858
Name:WORTH, KELLY JOY (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JOY
Last Name:WORTH
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 1:1828 OLD GRAY SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-5523
Mailing Address - Country:US
Mailing Address - Phone:636-358-2333
Mailing Address - Fax:
Practice Address - Street 1:1828 OLD GRAY SUMMIT RD
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-5523
Practice Address - Country:US
Practice Address - Phone:636-358-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor