1952482671 NPI number — KELSEY CHIROPRACTIC PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952482671 NPI number — KELSEY CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELSEY CHIROPRACTIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952482671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 WALL STREET
Provider Second Line Business Mailing Address:
SUITE 22
Provider Business Mailing Address City Name:
VALPARAISO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46383-2563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-477-4114
Provider Business Mailing Address Fax Number:
219-548-8482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 WALL STREET
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
VALPARAISO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46383-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-477-4114
Provider Business Practice Location Address Fax Number:
219-548-8482
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELSEY
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
STEPHANIE
Authorized Official Title or Position:
PRESIDENT OF PROFESSIONAL CORP
Authorized Official Telephone Number:
219-477-4114

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001339A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000273199 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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