Provider Demographics
NPI:1033217328
Name:KELLERMANN, ROBERT GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:KELLERMANN
Suffix:
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 1:606 S NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4618
Mailing Address - Country:US
Mailing Address - Phone:848-224-4333
Mailing Address - Fax:224-848-4378
Practice Address - Street 1:606 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4618
Practice Address - Country:US
Practice Address - Phone:224-848-4333
Practice Address - Fax:224-848-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010730111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician