Provider Demographics
NPI:1497510879
Name:FUNCTIONAL & INTEGRATIVE CHIROPRACTIC SOLUTIONS PLLC
Entity Type:Organization
Organization Name:FUNCTIONAL & INTEGRATIVE CHIROPRACTIC SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-249-1909
Mailing Address - Street 1:1853 51ST ST NE STE 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2407
Mailing Address - Country:US
Mailing Address - Phone:319-249-1909
Mailing Address - Fax:319-249-1908
Practice Address - Street 1:1853 51ST ST NE STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2407
Practice Address - Country:US
Practice Address - Phone:319-249-1909
Practice Address - Fax:319-249-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty