Provider Demographics
NPI:1558928952
Name:MCCLURE, KELSI (DC)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:MCCLURE
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 1:31395 7 MILE RD STE G
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4335
Mailing Address - Country:US
Mailing Address - Phone:248-426-6600
Mailing Address - Fax:
Practice Address - Street 1:5690 W 88TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3005
Practice Address - Country:US
Practice Address - Phone:303-536-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010821111N00000X
COCHR.0008230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor