Provider Demographics
NPI:1558938647
Name:CHADWICK, KELSEY (RD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROBIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1276
Mailing Address - Country:US
Mailing Address - Phone:978-882-3908
Mailing Address - Fax:
Practice Address - Street 1:8 ROBIN HILL RD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1276
Practice Address - Country:US
Practice Address - Phone:978-882-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86148522133V00000X
MA5278133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered