Individual provider Active NPI

Mary P Kelly, D.C.

  • Chiropractor
  • Waterloo, IA
National Provider Identifier
1922280387
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06386 Issued in IA
Practice address
3602 Kimball Ave
Waterloo, IA 50702-5731
Phone
(319) 233-9355
NPI assigned
Nov 28, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 06386 IA Primary

Addresses

Primary practice location

3602 Kimball Ave
Waterloo, IA 50702-5731

Mailing address

904 Hudson Rd
Cedar Falls, IA 50613-2305
Phone (319) 415-3062

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080530000470 IA Practitioner - Chiropractic 0345310561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3602 Kimball Ave
Waterloo, IA 50702-5731
Phone (319) 236-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
06386IAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Kuhn Chiropractic, PC Chiropractor CurrentSince Apr 1, 2025 Accepting new patients
Gress Chiropractic Clinic, LLC Chiropractor PastSince Mar 20, 2007 Accepting new patients
Dr. Bradley Kristiansen Chiropractic, P.C. Chiropractor Past Accepting new patients
Advanced Health PastSince Jan 13, 2003 Accepting new patients
Synergy Chiropractic & Wellness Center Chiropractor PastSince Sep 13, 2011 Accepting new patients

Locations

1125 W 4th St
Ste A
Waterloo, IA 50702
Phone (319) 233-9355

3602 Kimball Ave
Waterloo, IA 50702
Phone (319) 233-9355

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1922280387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 HUDSON RD",
            "city": "CEDAR FALLS",
            "state": "IA",
            "postal_code": "506132305",
            "telephone_number": "319-415-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3602 KIMBALL AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025731",
            "telephone_number": "319-233-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-28",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "06386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; 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.