Provider Demographics
NPI:1477112761
Name:GAEDTKE, KELSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:GAEDTKE
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:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:HILBERT
Mailing Address - State:WI
Mailing Address - Zip Code:54129-0412
Mailing Address - Country:US
Mailing Address - Phone:920-973-1323
Mailing Address - Fax:920-253-2842
Practice Address - Street 1:511 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILBERT
Practice Address - State:WI
Practice Address - Zip Code:54129-9490
Practice Address - Country:US
Practice Address - Phone:920-973-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5465-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor