Healthcare Provider Details

I. General information

NPI: 1225382815
Provider Name (Legal Business Name): LORI KELSEY ACUPUNCTURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2012
Last Update Date: 11/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6556 WINDING RIDGE LOOP
SANTA FE NM
87507-3187
US

IV. Provider business mailing address

6556 WINDING RIDGE LOOP
SANTA FE NM
87507-3187
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-0459
  • Fax:
Mailing address:
  • Phone: 575-770-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: