Provider Demographics
NPI:1285006197
Name:KELLER, ANTON LEROY (DC)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:LEROY
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 1:515 7TH AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4949
Mailing Address - Country:US
Mailing Address - Phone:907-456-4234
Mailing Address - Fax:
Practice Address - Street 1:10400 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-8003
Practice Address - Country:US
Practice Address - Phone:740-467-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor