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 1:116 VALLEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:208-874-7249
Mailing Address - Fax:
Practice Address - Street 1:4413 TOWN CENTER PARKWAY
Practice Address - Street 2:STE. 205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:904-204-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor