Provider Demographics
NPI:1528448966
Name:KELLY, BROOKE ELIZABETH JANE (DC, DVC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ELIZABETH JANE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DC, DVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 SAWDUST RD STE 801
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2580
Mailing Address - Country:US
Mailing Address - Phone:281-364-1496
Mailing Address - Fax:
Practice Address - Street 1:2219 SAWDUST RD STE 801
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2580
Practice Address - Country:US
Practice Address - Phone:281-364-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor