Provider Demographics
NPI:1649284936
Name:FLESHOOD, KELL W (DC)
Entity type:Individual
Prefix:DR
First Name:KELL
Middle Name:W
Last Name:FLESHOOD
Suffix:
Gender:M
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:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0794
Mailing Address - Country:US
Mailing Address - Phone:434-447-8996
Mailing Address - Fax:434-955-2582
Practice Address - Street 1:107 N BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1909
Practice Address - Country:US
Practice Address - Phone:434-447-8996
Practice Address - Fax:434-955-2582
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA333060OtherBCBS OF VA
VA350000851Medicare ID - Type Unspecified
VAT21636Medicare UPIN