Kelly Chiropractic, PC
Organization Active NPI Chiropractor · Garrison, ND
NPI 1811080682 · NPPES record last updated Oct 31, 2008
Key facts
- NPI
- 1811080682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 749 (ND)
- Legal business name
- KELLY CHIROPRACTIC, PC
- Practice address
- 141 N Main St
Garrison, ND 58540-7170 - Phone
- (701) 837-5733
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael Kelly Jr., DC
- Title
- Chiropractor
- Phone
- (701) 837-5733
Other NPIs on the same Medicare enrollment 1
Practitioners 3
-
Krista C Kelly, D.C.
-
Michael A Kelly Jr., D.C.
-
Amy Lou Ellenbecker, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040903000896 | ND | Part B Supplier - Clinic/Group Practice | 3678549334 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Minot, ND |
National Provider Directory
Locations
141 N Main St
Garrison, ND 58540
Phone (701) 463-2988
1415 2nd Ave SW
Minot, ND 58701
Phone (701) 837-5733
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 749 | ND | Yes |
| Chiropractor |
111N00000X | 762 | ND |
Addresses
Primary practice location
141 N Main St
Garrison, ND 58540-7170
Mailing address
1415 2ND Ave SW
Minot, ND 58701-3629
Phone (701) 837-5733
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13526 | Medicaid | ND |
Other providers in Garrison, ND
- Vern Allen Harchenko
- Kelly C Heinze
- Forrest Leroy Hirsch
- Heather Leah Hunt
- Tammy K Iglehart
- Lakeview Chiropractic
- Nicole Larson
- Jacquelyn A Liffrig
- Paul Reynes Minoza
- Kurt D Olson
All providers in Garrison, ND · Chiropractor in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.