Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 9868 | TX |
N | 111NN1001X | Nutrition | 9868 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 9868 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 9868 | TX |
N | 111NX0100X | Occupational Health | 9868 | TX |
NPI | 1548389166 |
---|---|
Provider Name | Dr. Scott Andrew Kelly |
First Address | San Antonio, TX 78232-5052 |
Second Address | Sugar Land, TX 77479-2350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VO1975 | (02) | TX |