Provider Demographics
NPI:1427194869
Name:DEEMS, KELLY R (DC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:DEEMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RENEE
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 537
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64013-0537
Mailing Address - Country:US
Mailing Address - Phone:816-229-6700
Mailing Address - Fax:816-229-6701
Practice Address - Street 1:1970 COPPER OAKS CIRCLE
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:816-229-6700
Practice Address - Fax:816-229-6701
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006186111N00000X
KS0104184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25538016OtherBLUE CROSS BLUE SHIELD
MO0006686AMedicare ID - Type Unspecified