Provider Demographics
NPI:1952482671
Name:KELSEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KELSEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PROFESSIONAL CORP
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-477-4114
Mailing Address - Street 1:402 WALL STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2563
Mailing Address - Country:US
Mailing Address - Phone:219-477-4114
Mailing Address - Fax:219-548-8482
Practice Address - Street 1:402 WALL STREET
Practice Address - Street 2:SUITE 22
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2563
Practice Address - Country:US
Practice Address - Phone:219-477-4114
Practice Address - Fax:219-548-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001339A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000273199OtherANTHEM
IN000000273199OtherANTHEM
IN205390Medicare ID - Type UnspecifiedGROUP
IN205390AMedicare ID - Type UnspecifiedPROVIDER