Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 33.015136 | OH |
NPI | 1013181098 |
---|---|
Provider Name | Mrs. Kelly Jo Brown |
First Address | Canal Winchester, OH 43110-1333 |
Second Address | Lancaster, OH 43130-8039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2008 |
Last Update Date | 21/04/2008 |