Provider Demographics
NPI:1982686168
Name:KELCHEN, MARY JO (DC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:KELCHEN
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:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:IA
Mailing Address - Zip Code:52045-0282
Mailing Address - Country:US
Mailing Address - Phone:563-876-3231
Mailing Address - Fax:563-876-3266
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EPWORTH
Practice Address - State:IA
Practice Address - Zip Code:52045-7717
Practice Address - Country:US
Practice Address - Phone:563-876-3231
Practice Address - Fax:563-876-3266
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47463OtherWELLMARK BCBS OF IA
IA0180802Medicaid
IA15794OtherMIDLANDS CHOICE
IA96585OtherHEALTH PARTNERS
IA0180802Medicaid
IA96585OtherHEALTH PARTNERS
IA47463OtherWELLMARK BCBS OF IA
IA15794OtherMIDLANDS CHOICE
IA0180802Medicaid