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Individual

KELLY JON CRIPE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
212 CEDAR ST, MONTICELLO, MN 55362
(763) 295-2262
(763) 295-6282
Mailing address
PO BOX 1638, MONTICELLO, MN 55362-1638
(763) 295-2262
(763) 295-6282

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4170
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
422L0MO
BCBS GIN
MN
01
422L1MO
BCBS PIN
MN
01
4278429-00
MN HEALTH CARE PROGRAMS
MN
01
641442
CCMI
MN
Enumeration date
03/26/2007
Last updated
07/08/2007
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