MEDICARE: DR. KELLEY RENEE SAMUEL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8420	TX

General Provider Information

NPI Number	:	1144326927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLEY RENEE SAMUEL DC

Provider Business Mailing Address
First Line	:	PO BOX 451494
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77245-1494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 S POST OAK RD STE 217
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-2021
Country	:	US
Telephone Number	:	713-574-5517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	04/23/2020

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