Provider Demographics
NPI:1124042106
Name:KELLY, CHAD ERIC (DC, PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ERIC
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W 20TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2400
Mailing Address - Country:US
Mailing Address - Phone:713-961-7852
Mailing Address - Fax:713-961-0812
Practice Address - Street 1:427 W 20TH ST STE 207
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2400
Practice Address - Country:US
Practice Address - Phone:713-961-7852
Practice Address - Fax:713-961-0812
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30938111NR0400X
TX8575111NS0005X
TX1219312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612955Medicare PIN