Provider Demographics
NPI:1558694851
Name:KELLER, CHRISTINE (LAC, DIPLOM)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18476 KENRICK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9288
Mailing Address - Country:US
Mailing Address - Phone:612-396-5622
Mailing Address - Fax:
Practice Address - Street 1:18476 KENRICK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9288
Practice Address - Country:US
Practice Address - Phone:612-396-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND834044950915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist