Provider Demographics
NPI:1770667602
Name:MCKELROY, JEREMY T (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:T
Last Name:MCKELROY
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 1:1000 E MATTHEWS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4344
Mailing Address - Country:US
Mailing Address - Phone:870-802-9355
Mailing Address - Fax:870-802-1057
Practice Address - Street 1:1000 E MATTHEWS AVE STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4344
Practice Address - Country:US
Practice Address - Phone:870-802-9355
Practice Address - Fax:870-802-1057
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157358718Medicaid
AR5W511Medicare PIN
AR157358718Medicaid