Healthcare Provider Details

I. General information

NPI: 1851336010
Provider Name (Legal Business Name): SEAN KELLY BRANHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 MANCHESTER RD
MAPLEWOOD MO
63143-3031
US

IV. Provider business mailing address

7411 MANCHESTER RD
MAPLEWOOD MO
63143-3031
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-1384
  • Fax: 314-781-1374
Mailing address:
  • Phone: 314-647-1384
  • Fax: 314-781-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: