Provider Demographics
NPI:1194863100
Name:KELLERMAN, DOUGLAS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:KELLERMAN
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 1:410 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1423
Mailing Address - Country:US
Mailing Address - Phone:954-561-4700
Mailing Address - Fax:954-561-0812
Practice Address - Street 1:410 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1423
Practice Address - Country:US
Practice Address - Phone:954-561-4700
Practice Address - Fax:954-561-0812
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53928AMedicare PIN