Provider Demographics
NPI:1679253173
Name:HOLSTROM, CHELSEY N (DC)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:N
Last Name:HOLSTROM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 METFIELD LN
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7871
Mailing Address - Country:US
Mailing Address - Phone:515-419-3856
Mailing Address - Fax:
Practice Address - Street 1:12351 W 96TH TER APT 207
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4410
Practice Address - Country:US
Practice Address - Phone:913-732-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty