Provider Demographics
NPI:1912990185
Name:BRAUCHLA, KELLY ANN (DC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BRAUCHLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:417 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-4019
Mailing Address - Country:US
Mailing Address - Phone:765-642-7246
Mailing Address - Fax:765-642-7246
Practice Address - Street 1:417 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4019
Practice Address - Country:US
Practice Address - Phone:765-642-7246
Practice Address - Fax:765-642-7246
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002193A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN227930AOtherMEDICARE ID
INU99440Medicare UPIN