Provider Demographics
NPI:1003065202
Name:KELLENBERGER, JOHN HOWARD SR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:KELLENBERGER
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 CAVILLER CT
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-2985
Mailing Address - Country:US
Mailing Address - Phone:239-656-0091
Mailing Address - Fax:239-489-1314
Practice Address - Street 1:14090 METROPOLIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4450
Practice Address - Country:US
Practice Address - Phone:239-489-4100
Practice Address - Fax:239-489-1314
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor