Provider Demographics
NPI:1851829139
Name:PETTITT, KELSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:PETTITT
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 1:60 SE LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8299
Mailing Address - Country:US
Mailing Address - Phone:515-325-4325
Mailing Address - Fax:
Practice Address - Street 1:60 SE LAUREL ST
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8299
Practice Address - Country:US
Practice Address - Phone:515-325-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor