Healthcare Provider Details

I. General information

NPI: 1033817994
Provider Name (Legal Business Name): ZACHARY BREN'N KELLY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E SANTA CLARA ST
VENTURA CA
93001-2937
US

IV. Provider business mailing address

380 VALMORE AVE
VENTURA CA
93003-4750
US

V. Phone/Fax

Practice location:
  • Phone: 805-567-8289
  • Fax:
Mailing address:
  • Phone: 805-220-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC36416
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC36416
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC36416
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC36416
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC36416
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC36416
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC36416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: