Provider Demographics
NPI:1851668321
Name:WELCH, KALLI MARCEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KALLI
Middle Name:MARCEL
Last Name:WELCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KAL
Other - Middle Name:MARCEL
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:372 W 12TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3493
Mailing Address - Country:US
Mailing Address - Phone:541-214-9015
Mailing Address - Fax:541-262-6991
Practice Address - Street 1:372 W 12TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3493
Practice Address - Country:US
Practice Address - Phone:541-214-9015
Practice Address - Fax:541-262-6991
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor