Provider Demographics
NPI:1649732140
Name:HUDSON, KELSEY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:MARIE
Last Name:HUDSON
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 1:4000 KRUSE WAY PL STE 3-245
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5598
Mailing Address - Country:US
Mailing Address - Phone:503-305-7244
Mailing Address - Fax:
Practice Address - Street 1:4000 KRUSE WAY PL STE 3-245
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5598
Practice Address - Country:US
Practice Address - Phone:503-305-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor