Healthcare Provider Details

I. General information

NPI: 1538446851
Provider Name (Legal Business Name): KELLY K. BRINKMAN, DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MAIN PLAZA DR
WENTZVILLE MO
63385-1170
US

IV. Provider business mailing address

1023 MAIN PLAZA DR
WENTZVILLE MO
63385-1170
US

V. Phone/Fax

Practice location:
  • Phone: 636-639-8944
  • Fax: 636-639-8922
Mailing address:
  • Phone: 636-639-8944
  • Fax: 636-639-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5824
License Number StateMO

VIII. Authorized Official

Name: DR. KELLY K. BRINKMAN
Title or Position: OWNER
Credential: D.C.
Phone: 314-800-8240