MEDICARE: DR. SHANE M KELLY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	TX8144	TX

General Provider Information

NPI Number	:	1407941552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE M KELLY DC

Provider Business Mailing Address
First Line	:	1445 N LOOP WEST
Second Line	:	SUITE 120
City	:	HOUSTON
State	:	TX
Zip	:	77008-1654
Country	:	US
Telephone Number	:	713-864-9355
Fax Number	:	713-864-7211

Provider Business Practice Location Address
First Line	:	1445 N LOOP WEST
Second Line	:	SUITE 120
City	:	HOUSTON
State	:	TX
Zip	:	77008-1654
Country	:	US
Telephone Number	:	713-864-9355
Fax Number	:	713-864-7211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	11/28/2007

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