Provider Demographics
NPI:1083694657
Name:KELLER, MICHAEL ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:KELLER
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 1:404 W. GRAND CROSSING
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-2046
Mailing Address - Country:US
Mailing Address - Phone:605-845-7808
Mailing Address - Fax:605-845-5808
Practice Address - Street 1:404 W. GRAND CROSSING
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-2046
Practice Address - Country:US
Practice Address - Phone:605-845-7808
Practice Address - Fax:605-845-5808
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7604004Medicaid
SDS104665Medicare PIN
SDU61485Medicare UPIN