Provider Demographics
NPI:1467501395
Name:KELLNER, BERNWART (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNWART
Middle Name:
Last Name:KELLNER
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 1:11 BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3519
Mailing Address - Country:US
Mailing Address - Phone:603-352-3817
Mailing Address - Fax:603-352-8701
Practice Address - Street 1:11 BRIDGE CT
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3519
Practice Address - Country:US
Practice Address - Phone:603-352-3817
Practice Address - Fax:603-352-8701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH159-0538-1084B111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHANTHEMOther50Y141700NH01
NHCIGNAOther2919716001
NH30011098Medicaid
NHHARVARD PILGRIMOtherT25823
NHCIGNAOther2919716001