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NPI Code Detail

MEDICARE: DR. BROOKE ELIZABETH JANE KELLY D.C., D.V.C.

MEDICARE: DR. BROOKE ELIZABETH JANE KELLY D.C., D.V.C.
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
1111N00000XChiropractor12957TX

General Provider Information

NPI Number : 1528448966
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BROOKE ELIZABETH JANE KELLY D.C., D.V.C.
Provider Business Mailing Address
First Line : 2219 SAWDUST RD STE 801
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77380-2580
Country : US
Telephone Number : 281-364-1496
Fax Number :
Provider Business Practice Location Address
First Line : 2219 SAWDUST RD STE 801
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77380-2580
Country : US
Telephone Number : 281-364-1496
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2015
Last Update Date : 06/01/2015

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