Organization
KELLY CHIROPRACTIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GWENDOLYN E KELLY-KOHNKE DC (PRESIDENT)
(763) 231-0143
Entity
Organization
Contact information
Practice address
8421 WAYZATA BLVD. SUITE 220, GOLDEN VALLEY, MN 55426
(763) 231-0143
Mailing address
16980 SADDLEWOOD TRL, MINNETONKA, MN 55345-2678
(612) 702-9206
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4183
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320S0KE
BLUE CROSS BLUE SHIELD #
—
Enumeration date
12/06/2006
Last updated
11/01/2010
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