Provider Demographics
NPI:1376926212
Name:SMADING, KELSEY (DC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SMADING
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 1:206 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2618
Mailing Address - Country:US
Mailing Address - Phone:785-742-7164
Mailing Address - Fax:816-436-7501
Practice Address - Street 1:206 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2618
Practice Address - Country:US
Practice Address - Phone:785-742-7164
Practice Address - Fax:816-436-7501
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015022046111N00000X
KS01-05738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor