Organization
SHERIDAN FAMILY CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH A KELLEY DC (OWNER)
(503) 843-3888
Entity
Organization
Contact information
Practice address
639 W MAIN, SHERIDAN, OR 97378
(503) 843-3888
(503) 843-4366
Mailing address
PO BOX 37, SHERIDAN, OR 97378-0037
(503) 843-3888
(503) 843-4366
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
651343
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059489000
REGENCE BC BS
—
01
—
112941
PERMANENTE
OR
Enumeration date
05/02/2008
Last updated
06/27/2015
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