Provider Demographics
NPI:1164405973
Name:KELSEY, AMANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 HADLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1022
Mailing Address - Country:US
Mailing Address - Phone:651-538-4558
Mailing Address - Fax:866-496-4047
Practice Address - Street 1:5705 HADLEY AVENUE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-1022
Practice Address - Country:US
Practice Address - Phone:651-538-4558
Practice Address - Fax:866-496-4047
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100961OtherHEALTH PARTNERS
MN56M14KEOtherBCBS
MN318655500Medicaid
MN350002765Medicare ID - Type Unspecified
MNU93369Medicare UPIN