Provider Demographics
NPI:1023445392
Name:KELLEY, SCOTT BRANDON (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRANDON
Last Name:KELLEY
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 1:1370 PANTHEON WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2341
Mailing Address - Country:US
Mailing Address - Phone:210-494-3000
Mailing Address - Fax:210-579-2382
Practice Address - Street 1:1370 PANTHEON WAY STE 160
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2341
Practice Address - Country:US
Practice Address - Phone:210-494-3000
Practice Address - Fax:210-579-2382
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor