Provider Demographics
NPI:1891154233
Name:KELLY, CHRISTINA (DC, CPM, LM)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:DC, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 CARLSBAD VILLAGE DR STE U
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1958
Mailing Address - Country:US
Mailing Address - Phone:760-730-7315
Mailing Address - Fax:
Practice Address - Street 1:11 10TH AVE S STE D
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7505
Practice Address - Country:US
Practice Address - Phone:952-452-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1101176B00000X
MN7203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No176B00000XOther Service ProvidersMidwife