Provider Demographics
NPI:1790793677
Name:PEARSON, KELLI K (DC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:K
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:K
Other - Last Name:PEARSON-WEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1410 NORTH MULLAN
Mailing Address - Street 2:STE 200
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-927-8997
Mailing Address - Fax:509-927-3919
Practice Address - Street 1:1410 NORTH MULLAN
Practice Address - Street 2:STE 200
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-927-8997
Practice Address - Fax:509-927-3919
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801711Medicare PIN
U23797Medicare UPIN