Individual
DR. GLENN RICHARD KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
100 ROTUNDA DR, STEPHENSON, VA 22656-1966
(703) 627-7553
Mailing address
100 ROTUNDA DR, STEPHENSON, VA 22656-1966
(703) 627-7553
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
010455985
VA
111NR0200X
Radiology Chiropractor
010455985
VA
111NR0400X
Rehabilitation Chiropractor
Primary
010455985
VA
111NS0005X
Sports Physician Chiropractor
010455985
VA
111NX0100X
Occupational Health Chiropractor
010455985
VA
111NX0800X
Orthopedic Chiropractor
010455985
VA
Other
Enumeration date
01/31/2007
Last updated
03/02/2022
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