NPIMap

Individual provider Active NPI

Jeffrey Alan Kelly, D.C.

  • Radiology Chiropractor
  • Saginaw, MI
National Provider Identifier
1932159928
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology ChiropractorTaxonomy code 111NR0200X
License
JK008789 Issued in MI
Practice address
4266 State St
Saginaw, MI 48603-4028
Phone
(989) 792-6702
Fax
(989) 792-1128
NPI assigned
May 11, 2006
Last updated
Feb 16, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Chiropractor 111NN1001X JK008789 MI
Radiology Chiropractor 111NR0200X JK008789 MI Primary

Addresses

Primary practice location

4266 State St
Saginaw, MI 48603-4028

Mailing address

2605 S Graham Rd
Saginaw, MI 48609-9616
Phone (989) 642-5421

Other identifiers 4

IdentifierTypeStateIssuer
950G311530OtherMIBCBS PIN NUMBER
0N24830OtherMIMEDICARE ID
0G30188OtherMIBCBS PIN
JK008789OtherMIBCBS LICENSE NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041118000717 MI Practitioner - Chiropractic 5294799250 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
JK008789MIMDNutrition Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Spine and Medical PLLC CurrentSince Feb 14, 2023 Accepting new patients
Holt Family Chiropractic PLLC CurrentSince Jan 1, 2020 Accepting new patients
Great Lakes Spine and Medical PLLC CurrentSince Mar 2, 2023 Accepting new patients
Great Lakes Spine and Medical PLLC Past Accepting new patients
Great Lakes Spine and Medical PLLC Past Accepting new patients

Locations

4573 Willoughby Rd
Ste B
Holt, MI 48842
Phone (517) 699-2646

4266 State St
Saginaw, MI 48603
Phone (989) 792-6702

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1932159928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 S GRAHAM RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486099616",
            "telephone_number": "989-642-5421",
            "fax_number": "989-792-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4266 STATE ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486034028",
            "telephone_number": "989-792-6702",
            "fax_number": "989-792-1128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "MI",
            "license": "JK008789",
            "primary": false
        },
        {
            "code": "111NR0200X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Radiology",
            "state": "MI",
            "license": "JK008789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN NUMBER",
            "identifier": "950G311530",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "0N24830",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "0G30188",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LICENSE NUMBER",
            "identifier": "JK008789",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.