Provider Demographics
NPI:1518975168
Name:KETTMANN, BRIAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:KETTMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 QUEENS RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502
Mailing Address - Country:US
Mailing Address - Phone:713-946-1347
Mailing Address - Fax:713-946-0379
Practice Address - Street 1:725 QUEENS RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502
Practice Address - Country:US
Practice Address - Phone:713-946-1347
Practice Address - Fax:713-946-0379
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX5095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor