NPIMap

Organization Active NPI

Brandon Kelley D.C. P.C.

Doing business as Sheridan Spine and Sports Medicine

  • Sports Physician Chiropractor
  • Sheridan, WY
National Provider Identifier
1831675479
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
779 Issued in WY
Legal business name
BRANDON KELLEY D.C. P.C.
Doing business as
Sheridan Spine and Sports Medicine
Practice address
1156 N Main St
Sheridan, WY 82801-3055
Phone
(307) 763-4556
NPI assigned
Jul 17, 2018
Last updated
Jul 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Authorized official

Name
Brandon Kelley, D.C.NPI 1154862951
Title
Physician
Phone
(307) 763-4556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 779 WY Primary

Addresses

Primary practice location

1156 N Main St
Sheridan, WY 82801-3055

Mailing address

1156 N Main St
Sheridan, WY 82801-3055
Phone (307) 763-4556

Other names 1

  • Sheridan Spine and Sports Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211118002937 WY Part B Supplier - Clinic/Group Practice 2163811779 Receives reassigned benefits from 3 practitioners
Practice locations: Sheridan, WY

National Provider Directory

National Provider Directory

Locations

371 Coffeen Ave
Sheridan, WY 82801
Phone (307) 763-4556

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531785600000",
    "number": "1831675479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1156 N MAIN ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013055",
            "telephone_number": "307-763-4556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1156 N MAIN ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013055",
            "telephone_number": "307-763-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON KELLEY D.C. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2018-07-17",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "307-763-4556",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WY",
            "license": "779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sheridan Spine and Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sheridan, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.