MEDICARE: DR. JEFFREY ALAN 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	111NN1001X	Nutrition Chiropractor	JK008789	MI
2	111NR0200X	Radiology Chiropractor	JK008789	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	0N24830	OTHER	MI	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0G30188	OTHER	MI	BCBS PIN
2	950G311530	OTHER	MI	BCBS PIN NUMBER
3	JK008789	OTHER	MI	BCBS LICENSE NUMBER

General Provider Information

NPI Number	:	1932159928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ALAN KELLY D.C.

Provider Business Mailing Address
First Line	:	2605 S GRAHAM RD
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48609-9616
Country	:	US
Telephone Number	:	989-642-5421
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	:	05/11/2006
Last Update Date	:	02/16/2023

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Directions to “ DR. JEFFREY ALAN KELLY D.C.” Practice Location

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