Provider Demographics
NPI:1174697791
Name:ARNOLD, KELLY D (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:ARNOLD
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 1:1121 SUDDEN VLY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4829
Mailing Address - Country:US
Mailing Address - Phone:360-715-3465
Mailing Address - Fax:
Practice Address - Street 1:3410 WOBURN ST # 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5643
Practice Address - Country:US
Practice Address - Phone:360-752-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031896Medicaid
WA8859640Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
WA2031896Medicaid
WA8859639Medicare ID - Type UnspecifiedMEDICARE GROUP