Provider Demographics
NPI:1902836406
Name:KELLING, BRIAN ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROSS
Last Name:KELLING
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 1:8420 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64167-1090
Mailing Address - Country:US
Mailing Address - Phone:816-415-8667
Mailing Address - Fax:
Practice Address - Street 1:310 S PLATTE CLAY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8500
Practice Address - Country:US
Practice Address - Phone:816-628-6141
Practice Address - Fax:816-628-6541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0005823Medicare ID - Type Unspecified