Provider Demographics
NPI:1932169596
Name:KELLS, SUSANN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:SUSANN
Middle Name:MARIE
Last Name:KELLS
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 1:6 WOODLAND TER
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7008
Mailing Address - Country:US
Mailing Address - Phone:814-934-2368
Mailing Address - Fax:814-695-4481
Practice Address - Street 1:1409 3RD AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-1254
Practice Address - Country:US
Practice Address - Phone:814-934-2368
Practice Address - Fax:814-695-4481
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 002046-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143938Medicare ID - Type Unspecified