Provider Demographics
NPI:1619219607
Name:SELLERS, KALY (DC)
Entity Type:Individual
Prefix:
First Name:KALY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 EASY ACRES LOOP
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-9739
Mailing Address - Country:US
Mailing Address - Phone:706-473-4375
Mailing Address - Fax:
Practice Address - Street 1:119 EASY ACRES LOOP
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-9739
Practice Address - Country:US
Practice Address - Phone:706-473-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY736111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition