Justin Kelly, DC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

111NS0005X Issued in MO

Practice address

8011 Maryland Avenue
St. Louis, MO 63105

Phone

(989) 619-4839

NPI assigned

Dec 28, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545955200000",
    "number": "1427520634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 SAN TANA CT",
            "city": "CEDAR HILL",
            "state": "MO",
            "postal_code": "63016",
            "telephone_number": "989-619-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8011 MARYLAND AVENUE",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63105",
            "telephone_number": "989-619-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-28",
        "last_updated": "2018-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "MO",
            "license": "111NS0005X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Kelly, MD
• James Edward Kelly, MD
• Jeannie Chen Kelly, MD
• Jeffrey Kelly
• John Kelly, M.D.
• Kari E Kelly
• Kim Kelly, PHD, LPC, NCC
• Melissa A. Kelly, FNP
• Stephanie Suzanne Kelly, RN
• Stephen J Kelly, MD

• Sports Physician Chiropractor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Sports Physician Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.