Provider Demographics
NPI:1134120785
Name:KELLEY, KURT ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:ALLEN
Last Name:KELLEY
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 1:20214 VETERANS DR
Mailing Address - Street 2:STE 300
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-6900
Mailing Address - Country:US
Mailing Address - Phone:402-359-1422
Mailing Address - Fax:402-359-1424
Practice Address - Street 1:20214 VETERANS DR
Practice Address - Street 2:STE 300
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-6900
Practice Address - Country:US
Practice Address - Phone:402-359-1422
Practice Address - Fax:402-359-1424
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09697OtherBCBS
NE10025237900Medicaid
246973OtherMIDLANDS CHOICE
V05092Medicare UPIN
NE099692Medicare ID - Type Unspecified