Provider Demographics
NPI:1407383250
Name:SPIDAHL, KELSEY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:MARIE
Last Name:SPIDAHL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1760
Mailing Address - Country:US
Mailing Address - Phone:701-240-9440
Mailing Address - Fax:
Practice Address - Street 1:300 3RD AVE SW
Practice Address - Street 2:F
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4346
Practice Address - Country:US
Practice Address - Phone:701-838-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor