Individual
DR. KELLY JAY KADOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3307 MILLER ST, BETHANY, MO 64424-2716
(660) 425-3312
(660) 425-3438
Mailing address
PO BOX 527, BETHANY, MO 64424-0527
(660) 425-3312
(660) 425-3438
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
005205
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20768013
BLUE CROSS BLUE SHIELD
MO
Enumeration date
06/17/2006
Last updated
01/16/2014
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