Provider Demographics
NPI:1497824452
Name:SCHALLER, KEITH HEINZ (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HEINZ
Last Name:SCHALLER
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 1:65 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1550
Mailing Address - Country:US
Mailing Address - Phone:802-244-1365
Mailing Address - Fax:802-244-0840
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1550
Practice Address - Country:US
Practice Address - Phone:802-244-1365
Practice Address - Fax:802-244-0840
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001123111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician