Provider Demographics
NPI:1225190358
Name:WELCH, KELLY DAVID (LAC)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:DAVID
Last Name:WELCH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 I ST NW STE 503A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-5407
Mailing Address - Country:US
Mailing Address - Phone:202-783-9404
Mailing Address - Fax:
Practice Address - Street 1:1800 I ST NW STE 503A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-5407
Practice Address - Country:US
Practice Address - Phone:202-783-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC30059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist