OrganizationKelly Chiropractic, PaChiropractorChiropractic ProvidersPractice Address8421 Wayzata Blvd. Suite 220, Golden Valley, MN 55426(763) 231-0143(612) 702-9206PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Chiropractic, Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1639237969Provider TypeOrganizationFull NameKelly Chiropractic, PaSubpartNoEnumeration Date12/6/2006Last Updated11/1/2010Contact InformationPractice LocationPractice Address8421 Wayzata Blvd. Suite 220, Golden Valley, MN 55426Phone(763) 231-0143FaxUnlisted FaxMailing LocationMailing Address16980 Saddlewood Trl, Minnetonka, MN 55345-2678Phone(612) 702-9206FaxUnlisted FaxAuthorized OfficialNameKelly-Kohnke, Gwendolyn E (President)Phone(763) 231-0143Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicense4183MinnesotaProvider IdentifiersIDDescriptionIssuerID320S0KEDescriptionOtherIssuerBLUE CROSS BLUE SHIELD #