Provider Demographics
NPI:1376054858
Name:KELLEY, WHITLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:WHITLEY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 GARDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-3668
Mailing Address - Country:US
Mailing Address - Phone:361-404-1252
Mailing Address - Fax:
Practice Address - Street 1:1421 GARDEN PARK DR
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-3668
Practice Address - Country:US
Practice Address - Phone:361-404-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13497OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS