Provider Demographics
NPI:1407109689
Name:BROWN, KELLY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:550 STANTON CHRISTIANA RD
Mailing Address - Street 2:STE. 302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2198
Mailing Address - Country:US
Mailing Address - Phone:302-365-5470
Mailing Address - Fax:302-365-6167
Practice Address - Street 1:550 STANTON CHRISTIANA RD
Practice Address - Street 2:STE. 302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2198
Practice Address - Country:US
Practice Address - Phone:302-365-5470
Practice Address - Fax:302-365-6167
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY12380111N00000X
DEF1-0000887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE348207ZUN2Medicare UPIN