Provider Demographics
NPI:1740934009
Name:CHAN, CHYNNA KELSEY (DC)
Entity type:Individual
Prefix:
First Name:CHYNNA
Middle Name:KELSEY
Last Name:CHAN
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 1:2779 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2412
Mailing Address - Country:US
Mailing Address - Phone:908-907-4050
Mailing Address - Fax:
Practice Address - Street 1:10850 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9290
Practice Address - Country:US
Practice Address - Phone:724-940-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty