Healthcare Provider Details

I. General information

NPI: 1922280387
Provider Name (Legal Business Name): MARY P KELLY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 KIMBALL AVE
WATERLOO IA
50702-5731
US

IV. Provider business mailing address

904 HUDSON RD
CEDAR FALLS IA
50613-2305
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-9355
  • Fax:
Mailing address:
  • Phone: 319-415-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06386
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: