Provider Demographics
NPI:1639435944
Name:KELCH CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:KELCH CHIROPRACTIC INC.
Other - Org Name:ALIGNLIFE NORTH PEORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-693-8448
Mailing Address - Street 1:7213 N ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1107
Mailing Address - Country:US
Mailing Address - Phone:309-693-8448
Mailing Address - Fax:309-693-8438
Practice Address - Street 1:7213 N ALLEN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1107
Practice Address - Country:US
Practice Address - Phone:309-693-8448
Practice Address - Fax:309-693-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty