Provider Demographics
NPI:1235148537
Name:LUELL, KEITH (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:LUELL
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 1:977 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE#103
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1400
Mailing Address - Country:US
Mailing Address - Phone:947-932-1079
Mailing Address - Fax:847-932-1082
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE#103
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:947-932-1079
Practice Address - Fax:847-932-1082
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor