Provider Demographics
NPI:1205246238
Name:KELLEY, BRET (DC)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:
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 1:8336 E 21ST ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2986
Mailing Address - Country:US
Mailing Address - Phone:316-733-8338
Mailing Address - Fax:
Practice Address - Street 1:8336 E 21ST ST N STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2986
Practice Address - Country:US
Practice Address - Phone:316-733-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor