Provider Demographics
NPI:1093235335
Name:KELSEY, DIANNA MARILYN (LAC, LMT, MS OM)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:MARILYN
Last Name:KELSEY
Suffix:
Gender:F
Credentials:LAC, LMT, MS OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-0109
Mailing Address - Country:US
Mailing Address - Phone:970-949-0444
Mailing Address - Fax:970-949-0883
Practice Address - Street 1:150 E BEAVER CREEK BLVD STE 106-B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5414
Practice Address - Country:US
Practice Address - Phone:970-949-0444
Practice Address - Fax:970-949-0883
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002048171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty