Provider Demographics
NPI:1871902494
Name:KELLY, ROBERT KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 KNOLL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-3316
Mailing Address - Country:US
Mailing Address - Phone:703-231-4609
Mailing Address - Fax:
Practice Address - Street 1:243 KNOLL WOODS DR
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588-3316
Practice Address - Country:US
Practice Address - Phone:703-231-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor