Brian Scott Kelley, DC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

2014-012 Issued in WI

Practice address

1503 Larson St
Bloomer, WI 54724-1632

Phone

(715) 568-4220

Fax

(715) 568-4201

NPI assigned

Jun 30, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kelley Chiropractic CenterGroup PAC ID 6608280722, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelley Chiropractic Center

  • Sports Physician Chiropractor
  • Bloomer, WI
  • NPI 1548305022
  Medicare reassignment Care Compare group
• Flynn Chiropractic, LLC

  • Chiropractor
  • Bloomer, WI
  • NPI 1447492319
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811994205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 LARSON ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241632",
            "telephone_number": "715-568-4220",
            "fax_number": "715-568-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 LARSON ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241632",
            "telephone_number": "715-568-4220",
            "fax_number": "715-568-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "BRIAN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WI",
            "license": "2014-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38796100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "392035966010",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elise Johnson, OTR
• Jenna Johnson, PTA
• Jill M Jones, PT
• Tracy Kampbell, PT
• Kelley Chiropractic Center
• Clare Gabrielle Kircher, OTR/L
• Steven D Klund, CRNA
• Myranda L Knez, PT
• Marie Konzen
• Courtney Dawn Kowalski

• Sports Physician Chiropractor in Bloomer, WI
• Providers in Bloomer, WI by specialty
• Sports Physician Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.