Individual
ADAM RICHARD KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
401 N OAK ST, APT. 4, NORMAL, IL 61761-2661
(309) 310-5762
Mailing address
401 N OAK ST, APT. 4, NORMAL, IL 61761-2661
(309) 310-5762
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/30/2014
Last updated
03/30/2014
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