Provider Demographics
NPI:1659091726
Name:100 CHIRO KELLER, PLLC.
Entity Type:Organization
Organization Name:100 CHIRO KELLER, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:BIS, DC
Authorized Official - Phone:815-977-1931
Mailing Address - Street 1:5956 N LINDER RD.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:815-977-1931
Mailing Address - Fax:
Practice Address - Street 1:5956 N LINDER RD.
Practice Address - Street 2:SUITE 120
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:815-977-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty