Provider Demographics
NPI:1548389166
Name:KELLY, SCOTT ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:911 CENTRAL PKWY N
Mailing Address - Street 2:300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5052
Mailing Address - Country:US
Mailing Address - Phone:800-404-6050
Mailing Address - Fax:866-313-3397
Practice Address - Street 1:16902 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2350
Practice Address - Country:US
Practice Address - Phone:832-584-7418
Practice Address - Fax:866-313-3397
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9868111NS0005X, 111NR0400X, 111NN0400X, 111NX0100X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVO1975Medicare UPIN