Basic Information
| Provider Information | |||||||||
| NPI: | 1548389166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 CENTRAL PKWY N | ||||||||
| Address2: | 300 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004046050 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Practice Location | |||||||||
| Address1: | 16902 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325847418 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 9868 | TX | N | Chiropractic Providers | Chiropractor | Sports Physician | 111NR0400X | 9868 | TX | Y | Chiropractic Providers | Chiropractor | Rehabilitation | 111NN0400X | 9868 | TX | N | Chiropractic Providers | Chiropractor | Neurology | 111NX0100X | 9868 | TX | N | Chiropractic Providers | Chiropractor | Occupational Health | 111NN1001X | 9868 | TX | N | Chiropractic Providers | Chiropractor | Nutrition |
No ID Information.