Provider Demographics
NPI:1720030984
Name:KELSEY, VICKI (D C)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 HOMESTEAD RD STE F
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-4601
Mailing Address - Country:US
Mailing Address - Phone:260-432-8777
Mailing Address - Fax:260-432-8777
Practice Address - Street 1:7127 HOMESTEAD RD STE F
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-4601
Practice Address - Country:US
Practice Address - Phone:260-432-8777
Practice Address - Fax:260-432-8777
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000682A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000091604OtherANTHEM
IN100253380AMedicaid
INT35116Medicare UPIN
IN862110BMedicare PIN
1720030984Medicare PIN
P00060475Medicare PIN