Provider Demographics
NPI:1013181098
Name:BROWN, KELLY JO (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6966 BADGER DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-1333
Mailing Address - Country:US
Mailing Address - Phone:614-829-3559
Mailing Address - Fax:
Practice Address - Street 1:1583 VICTOR RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8039
Practice Address - Country:US
Practice Address - Phone:740-653-5390
Practice Address - Fax:740-653-2808
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015136111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$-00OtherOHIO BUREAU OF WORKERS' COMPENSATION