Provider Demographics
NPI:1710402862
Name:KELSOE, TONY WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:WAYNE
Last Name:KELSOE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 E BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-2946
Mailing Address - Country:US
Mailing Address - Phone:682-429-7699
Mailing Address - Fax:
Practice Address - Street 1:626 E BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-2946
Practice Address - Country:US
Practice Address - Phone:979-345-6325
Practice Address - Fax:979-848-3306
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008261111N00000X
TX13569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor