Provider Demographics
NPI:1922280387
Name:KELLY, MARY P (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
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 1:6301 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5200
Mailing Address - Country:US
Mailing Address - Phone:319-233-9355
Mailing Address - Fax:
Practice Address - Street 1:6301 UNIVERSITY AVE
Practice Address - Street 2:SUITE 1250
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-5200
Practice Address - Country:US
Practice Address - Phone:319-233-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06386111N00000X
WI4545-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor