Provider Demographics
NPI:1497968739
Name:TODD F KELLEHER DC PC
Entity Type:Organization
Organization Name:TODD F KELLEHER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-986-6444
Mailing Address - Street 1:PO BOX 2320
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-2320
Mailing Address - Country:US
Mailing Address - Phone:478-986-6444
Mailing Address - Fax:478-986-1254
Practice Address - Street 1:4292 GRAY HWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5900
Practice Address - Country:US
Practice Address - Phone:478-986-6444
Practice Address - Fax:478-986-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3977Medicare ID - Type Unspecified