Provider Demographics
NPI:1144541848
Name:CHAMBERS, KELLY ANN (MAOM, LAC, DIPL AC)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ANN
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MAOM, LAC, DIPL AC
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:ANNE
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MAOM, DIPL AC
Mailing Address - Street 1:1530 NW 4TH ST
Mailing Address - Street 2:APT. #26
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1825
Mailing Address - Country:US
Mailing Address - Phone:541-390-1710
Mailing Address - Fax:541-617-8906
Practice Address - Street 1:365 NE KEARNEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4573
Practice Address - Country:US
Practice Address - Phone:541-390-1710
Practice Address - Fax:541-617-8906
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC151013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist