Maxwell Hayes Kelly, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH61115448 Issued in WA

Practice address

1625 W 4TH Ave Lowr 200
Spokane, WA 99201-5620

Phone

(509) 624-5855

Fax

(509) 838-5779

NPI assigned

Nov 16, 2020

Sex

Male

Sole proprietor

No

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

Enrolled in WA

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College - West, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fourth Avenue Chiropractic ClinicGroup PAC ID 9234025586, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Networks

• WA PPO C-SNP
• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fourth Avenue Chiropractic Clinic

  • Chiropractor
  • Spokane, WA
  • NPI 1578774360
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1053913855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 W 4TH AVE LOWR 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992015620",
            "telephone_number": "509-624-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 W 4TH AVE LOWR 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992015620",
            "telephone_number": "509-624-5855",
            "fax_number": "509-838-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MAXWELL",
        "middle_name": "HAYES",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH61115448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Lee Kelly, SUDP
• Kimberly Cherie Kelly
• Laurel Lea Kelly, LICSW
• Lillian Kelly
• Lisabeth Carlisle Kelly, M.D.
• Nicholas Kelly, PT
• Sara Kelly
• Sarah Kelly
• Tara B Kelly, LMHCA
• Teresa M Kelly, A.R.N.P.

• Chiropractor in Spokane, WA
• Providers in Spokane, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.