Provider Demographics
NPI:1306912969
Name:MURIE, KELLY EARL JR (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:EARL
Last Name:MURIE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 W STATE ST STE 12
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2074
Mailing Address - Country:US
Mailing Address - Phone:435-635-7771
Mailing Address - Fax:435-635-7701
Practice Address - Street 1:1141 W STATE ST STE 12
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2074
Practice Address - Country:US
Practice Address - Phone:435-635-7771
Practice Address - Fax:435-635-7701
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6052432-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6595Medicaid
UT60524321277001OtherBCBS
UTD6595Medicaid