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General NPI Number Information
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NPI Number | 1962119354
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Entity Type | Organization
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Legal Business Name | KELLEY SPORTS AND WELLNESS, PLLC
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 04/23/2023
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Provider Practice Location Address
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Address Line | 3710 CENTER ST UNIT 101
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City | DEER PARK
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State | TX
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Zip | 77536-6104
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Country | US
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Telephone | 346-701-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 GARDEN PARK DR
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City | DEER PARK
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State | TX
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Zip | 77536-3668
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Country | US
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Telephone | 361-404-1252
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | WHITLEY KELLEY
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Credential | D.C.
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Telephone | 361-404-1252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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