Provider Demographics
NPI:1982728549
Name:DR. ANGELA D KELLY
Entity Type:Organization
Organization Name:DR. ANGELA D KELLY
Other - Org Name:DBA: NORTHAMPTON WELLNESS INSTITUTE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-868-6150
Mailing Address - Street 1:4329 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1431
Mailing Address - Country:US
Mailing Address - Phone:610-868-6150
Mailing Address - Fax:610-868-6152
Practice Address - Street 1:4329 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1431
Practice Address - Country:US
Practice Address - Phone:610-868-6150
Practice Address - Fax:610-868-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007774-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01973889Medicaid
PA01973889Medicaid
PA070953SEUMedicare ID - Type Unspecified