Healthcare Provider Details

I. General information

NPI: 1376926212
Provider Name (Legal Business Name): KELSEY STALLBAUMER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S 1ST ST
HIAWATHA KS
66434-2618
US

IV. Provider business mailing address

206 S 1ST ST
HIAWATHA KS
66434-2618
US

V. Phone/Fax

Practice location:
  • Phone: 785-742-7164
  • Fax: 816-436-7501
Mailing address:
  • Phone: 785-742-7164
  • Fax: 816-436-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015022046
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05738
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: