Provider Demographics
NPI:1689893000
Name:KELSO, BRAD (DC)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:
Last Name:KELSO
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 1:6018 NE ST JOHNS RD STE C
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1781
Mailing Address - Country:US
Mailing Address - Phone:360-993-0711
Mailing Address - Fax:
Practice Address - Street 1:6018 NE ST JOHNS RD STE C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1781
Practice Address - Country:US
Practice Address - Phone:360-993-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCH00034070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor