Healthcare Provider Details

I. General information

NPI: 1245076702
Provider Name (Legal Business Name): RYAN CHRISTOPHER KELLY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 MAIN ST
VAN METER IA
50261-7711
US

IV. Provider business mailing address

527 MAIN ST
VAN METER IA
50261-7711
US

V. Phone/Fax

Practice location:
  • Phone: 515-518-0740
  • Fax: 515-337-8996
Mailing address:
  • Phone: 515-518-0740
  • Fax: 515-337-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: