Organization
KELLY CHIROPRACTIC CENTER OF WALLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD GARRETT KELLY D.C. (PRESIDENT)
(910) 214-6887
Entity
Organization
Contact information
Practice address
112 MEDICAL VILLAGE DR, SUITE A, WALLACE, NC 28466-1668
(910) 285-9002
Mailing address
PO BOX 1917, CLINTON, NC 28329-1917
(910) 285-9002
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2714
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0841K
BLUE CROSS BLUE SHIELD
—
01
—
0845C
BLUE CROSS BLUE SHIELD
—
05
—
890841K
—
NC
05
—
890845C
—
NC
Enumeration date
10/09/2007
Last updated
03/20/2008
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