Provider Demographics
NPI:1205364585
Name:KEY POTENTIAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KEY POTENTIAL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-325-4325
Mailing Address - Street 1:60 SE LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8299
Mailing Address - Country:US
Mailing Address - Phone:515-325-4325
Mailing Address - Fax:
Practice Address - Street 1:60 SE LAUREL ST
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8299
Practice Address - Country:US
Practice Address - Phone:515-325-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty