Provider Demographics
NPI:1801844568
Name:KELSALL, KAREN B (DC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:B
Last Name:KELSALL
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 1:1615 NW 23RD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2557
Mailing Address - Country:US
Mailing Address - Phone:503-223-8719
Mailing Address - Fax:503-223-3237
Practice Address - Street 1:1615 NW 23RD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2557
Practice Address - Country:US
Practice Address - Phone:503-223-8719
Practice Address - Fax:503-223-3237
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272997111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU64819Medicare UPIN