Provider Demographics
NPI:1336166073
Name:KELSEY, JEANNE STEPHANIE (DC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:STEPHANIE
Last Name:KELSEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:STEPHANIE
Other - Last Name:KELSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1052 MARSH ST
Mailing Address - Street 2:STE E
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6272
Mailing Address - Country:US
Mailing Address - Phone:219-548-4404
Mailing Address - Fax:219-548-4405
Practice Address - Street 1:1052 MARSH ST.
Practice Address - Street 2:STE E
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6272
Practice Address - Country:US
Practice Address - Phone:219-548-4404
Practice Address - Fax:219-548-4405
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001339A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000273199OtherANTHEM
IN205390AMedicare ID - Type UnspecifiedPROVIDER
IN205390Medicare ID - Type UnspecifiedGROUP
T02005Medicare UPIN