Provider Demographics
NPI:1659035129
Name:KEITH, KELSIE (DC)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:KEITH
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 1:1336 LEAGUE LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3457
Mailing Address - Country:US
Mailing Address - Phone:936-230-5515
Mailing Address - Fax:936-230-5516
Practice Address - Street 1:1336 LEAGUE LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3457
Practice Address - Country:US
Practice Address - Phone:936-230-5515
Practice Address - Fax:936-230-5516
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor