Provider Demographics
NPI:1851336010
Name:BRANHAM, SEAN KELLY (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:KELLY
Last Name:BRANHAM
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 1:7411 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3031
Mailing Address - Country:US
Mailing Address - Phone:314-647-1384
Mailing Address - Fax:314-781-1374
Practice Address - Street 1:7411 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3031
Practice Address - Country:US
Practice Address - Phone:314-647-1384
Practice Address - Fax:314-781-1374
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type Unspecified