Individual
DR. BRIAN SCOTT KELLEY
Active
Individual
DR. BRIAN SCOTT KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
2014-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38796100
—
WI
01
—
392035966010
BCBS
WI
Enumeration date
06/30/2005
Last updated
07/08/2007
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