Active NPI
Glenn Richard Kelly, DC
- Rehabilitation Chiropractor
- Stephenson, VA
National Provider Identifier
1245377282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 010455985
- Practice address
- 100 Rotunda Dr
Stephenson, VA 22656-1966 - Phone
- (703) 627-7553
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Chiropractor | 111NN0400X | 010455985 | VA | |
| Radiology Chiropractor | 111NR0200X | 010455985 | VA | |
| Sports Physician Chiropractor | 111NS0005X | 010455985 | VA | |
| Occupational Health Chiropractor | 111NX0100X | 010455985 | VA | |
| Orthopedic Chiropractor | 111NX0800X | 010455985 | VA | |
| Rehabilitation Chiropractor | 111NR0400X | 010455985 | VA | Primary |
Addresses
Primary practice location
100 Rotunda Dr
Stephenson, VA 22656-1966
Mailing address
100 Rotunda Dr
Stephenson, VA 22656-1966
Phone (703) 627-7553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010455985 | VA | MD | Neurology Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646179200000",
"number": "1245377282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 ROTUNDA DR",
"city": "STEPHENSON",
"state": "VA",
"postal_code": "226561966",
"telephone_number": "703-627-7553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 ROTUNDA DR",
"city": "STEPHENSON",
"state": "VA",
"postal_code": "226561966",
"telephone_number": "703-627-7553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "GLENN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2022-03-02",
"certification_date": "2022-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "111NN0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Neurology",
"state": "VA",
"license": "010455985",
"primary": false
},
{
"code": "111NR0200X",
"taxonomy_group": "",
"desc": "Chiropractor, Radiology",
"state": "VA",
"license": "010455985",
"primary": false
},
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "VA",
"license": "010455985",
"primary": false
},
{
"code": "111NX0100X",
"taxonomy_group": "",
"desc": "Chiropractor, Occupational Health",
"state": "VA",
"license": "010455985",
"primary": false
},
{
"code": "111NX0800X",
"taxonomy_group": "",
"desc": "Chiropractor, Orthopedic",
"state": "VA",
"license": "010455985",
"primary": false
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "VA",
"license": "010455985",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stephenson, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.