Healthcare Provider Details

I. General information

NPI: 1891154233
Provider Name (Legal Business Name): CHRISTINA KELLY DC, CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 10TH AVE S STE D
HOPKINS MN
55343-7505
US

IV. Provider business mailing address

1207 CARLSBAD VILLAGE DR STE U
CARLSBAD CA
92008-1958
US

V. Phone/Fax

Practice location:
  • Phone: 952-452-9712
  • Fax:
Mailing address:
  • Phone: 760-730-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1101
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7203
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: