Provider Demographics
NPI:1225382815
Name:KELSEY, LORI (ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6556 WINDING RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3187
Mailing Address - Country:US
Mailing Address - Phone:575-770-0459
Mailing Address - Fax:
Practice Address - Street 1:6556 WINDING RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3187
Practice Address - Country:US
Practice Address - Phone:575-770-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMLORI KELSEYOtherFEIN:46-1140670, CRS:03-254196-00-1