MEDICARE: DR. JOHN MICHAEL KELLY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	JK004908	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350005936	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0993966	OTHER	MI	HEALTH PLUS
4	950G350220	OTHER	MI	BCBS PIN
5	0G35022	OTHER	MI	BCN

General Provider Information

NPI Number	:	1801896444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL KELLY D.C.

Provider Business Mailing Address
First Line	:	4266 STATE ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-4028
Country	:	US
Telephone Number	:	989-792-6702
Fax Number	:	989-792-1128

Provider Business Practice Location Address
First Line	:	4266 STATE ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-4028
Country	:	US
Telephone Number	:	989-792-6702
Fax Number	:	989-792-1128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/15/2011

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Directions to “ DR. JOHN MICHAEL KELLY D.C.” Practice Location

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