Healthcare Provider Details

I. General information

NPI: 1134086614
Provider Name (Legal Business Name): KELSEY MATTAS DACHM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 E INDIAN SCHOOL RD # 42&63
PHOENIX AZ
85016-6807
US

IV. Provider business mailing address

1666 S EXTENSION RD APT 12-208
MESA AZ
85210-9339
US

V. Phone/Fax

Practice location:
  • Phone: 480-375-1074
  • Fax:
Mailing address:
  • Phone: 850-585-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number012222
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: