Provider Demographics
NPI:1366865537
Name:HUNTER, KELI
Entity Type:Individual
Prefix:MISS
First Name:KELI
Middle Name:
Last Name:HUNTER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:H
Other - Last Name:SORKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, DC
Mailing Address - Street 1:683 N. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:215-560-8575
Mailing Address - Fax:215-560-8589
Practice Address - Street 1:683 N. BROAD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123
Practice Address - Country:US
Practice Address - Phone:215-560-8575
Practice Address - Fax:215-560-8589
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASO585062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASO585062OtherSTATE LICENSE NUMBER
PA1902921471OtherINDIVIDUAL NPI
PASO585062OtherSTATE LICENSE NUMBER