Provider Demographics
NPI:1386290898
Name:CLEVENGER, KELSEY R (DC)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:R
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:R
Other - Last Name:BLUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:677 WOODLAND SQ LOOP SE
Mailing Address - Street 2:STE 6
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-349-8815
Mailing Address - Fax:360-352-8868
Practice Address - Street 1:677 WOODLAND SQ LOOP SE
Practice Address - Street 2:STE 6
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-349-8815
Practice Address - Fax:360-352-8868
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor