Smith, Kelly Wade

Smith, Kelly Wade is an individual health care provider with primary practice located at 104 W Lincoln Ave , Fergus Falls MN 56537-2123. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Smith, Kelly Wade can be contacted via phone (218) 736-4113.

Contact Information

Primary practice address
104 W Lincoln Ave Fergus Falls MN 56537-2123
Phone: (218) 736-4113
Fax: (218) 998-4337
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 3250 Minnesota

Profile Details

NPI number 1912994476
LBN Legal business name Smith, Kelly Wade
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2005
Last updated Feb 27th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912994476 NPPES
Minnesota Other 4C542SM BLUE CROSS/BLUE SHIELD
Minnesota Other 231907 BLUE CROSS/BLUE SHIELD

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