Provider Demographics
NPI:1073651055
Name:KEENER, KELLY LYNN (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:KEENER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:205 LARISTONE CT
Mailing Address - Street 2:PROVIDENCE HILLS
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-5504
Mailing Address - Country:US
Mailing Address - Phone:302-223-6886
Mailing Address - Fax:302-422-2900
Practice Address - Street 1:375 MULLET RUN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5373
Practice Address - Country:US
Practice Address - Phone:302-422-3100
Practice Address - Fax:302-422-2900
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3654798OtherAETNA
DE463526OtherIBC & HIGHMARK
DE0149056000OtherAMERIHEALTH
DE463526OtherIBC & HIGHMARK
DEU72279Medicare UPIN