Basic Information
| Provider Information | |||||||||
| NPI: | 1134253495 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KELLY A FALLON DC LTD | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1360 N SANDBURG TER | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606102075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129444653 | ||||||||
| FaxNumber: | 3129440747 | ||||||||
| Practice Location | |||||||||
| Address1: | 1360 N SANDBURG TER | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606102075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129444653 | ||||||||
| FaxNumber: | 3129440747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FALLON | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6308819183 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.