Provider Demographics
NPI:1093806309
Name:KELLY, MICHAEL G (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6441
Mailing Address - Country:US
Mailing Address - Phone:701-838-8000
Mailing Address - Fax:701-838-8444
Practice Address - Street 1:720 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6441
Practice Address - Country:US
Practice Address - Phone:701-838-8000
Practice Address - Fax:701-838-8444
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0845COtherBCBS
NC350051893OtherRAILROAD MEDICARE
NC890845CMedicaid
NCU78061Medicare UPIN