Healthcare Provider Details

I. General information

NPI: 1013181098
Provider Name (Legal Business Name): KELLY JO BROWN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 VICTOR RD NW
LANCASTER OH
43130-8039
US

IV. Provider business mailing address

6966 BADGER DR
CANAL WINCHESTER OH
43110-1333
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-5390
  • Fax: 740-653-2808
Mailing address:
  • Phone: 614-829-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number33.015136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: