Provider Demographics
NPI:1265553192
Name:THESIER, KELLI JO (DC)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:JO
Last Name:THESIER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KELLI
Other - Middle Name:JO
Other - Last Name:GUYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:20284 COUNTY ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-9502
Mailing Address - Country:US
Mailing Address - Phone:315-778-3054
Mailing Address - Fax:
Practice Address - Street 1:20284 COUNTY ROUTE 45
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9502
Practice Address - Country:US
Practice Address - Phone:315-778-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011-059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11059-5WOtherWORKMAN COMP-NO FAULT