Provider Demographics
NPI:1780658609
Name:KELLY, GRACE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 5TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2902
Mailing Address - Country:US
Mailing Address - Phone:563-505-7334
Mailing Address - Fax:
Practice Address - Street 1:1440 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1853
Practice Address - Country:US
Practice Address - Phone:319-354-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06765111N00000X
NJ38MC00617000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0470278Medicaid
IA0470278Medicaid
IAI15927Medicare ID - Type Unspecified