MEDICARE: DR. VICKI KELSEY D. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08000682A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000091604	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720030984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI KELSEY D. C.

Provider Business Mailing Address
First Line	:	7127 HOMESTEAD RD STE F
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-4601
Country	:	US
Telephone Number	:	260-432-8777
Fax Number	:	260-432-8777

Provider Business Practice Location Address
First Line	:	7127 HOMESTEAD RD STE F
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-4601
Country	:	US
Telephone Number	:	260-432-8777
Fax Number	:	260-432-8777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	05/18/2020

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