Provider Demographics
NPI:1194421123
Name:KIELTY, AAVRIE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:AAVRIE
Middle Name:MARIE
Last Name:KIELTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 45TH ST S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5510
Mailing Address - Country:US
Mailing Address - Phone:701-532-2523
Mailing Address - Fax:
Practice Address - Street 1:4711 45TH ST S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5510
Practice Address - Country:US
Practice Address - Phone:701-532-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor